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General NPI Number Information
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NPI Number | 1528654860
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Entity Type | Organization
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Legal Business Name | LA EDAD DORADA CORP
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Dates
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Enumeration Date | 12/20/2020
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Last Update Date | 12/20/2020
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Provider Practice Location Address
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Address Line | 1071 NW 119TH ST
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City | NORTH MIAMI
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State | FL
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Zip | 33168-6240
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Country | US
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Telephone | 786-803-8271
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Fax | 786-803-8291
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Provider Business Mailing Address
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Address Line | 1071 NW 119TH ST
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City | NORTH MIAMI
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State | FL
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Zip | 33168-6240
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Country | US
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Telephone | 786-803-8271
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Fax | 786-803-8291
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Authorized Official
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Title or Position | PRESIDENT
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Name | JORGE CLAVERO
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Credential |
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Telephone | 786-553-2717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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