=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235518812
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOLD HEALTH INSTITUTE CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2015
-----------------------------------------------------
Last Update Date | 05/28/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4355 W 16TH AVE STE 203
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012-7666
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-683-3196
-----------------------------------------------------
Fax | 844-628-4556
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4355 W 16TH AVE STE 203
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012-7666
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-683-3196
-----------------------------------------------------
Fax | 844-628-4556
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARIALYS SANTANA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-683-3196
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------