MEDICARE: GOLD HEALTH CENTER LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1205224326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLD HEALTH CENTER LLC.

Provider Business Mailing Address
First Line	:	2520 CORAL WAY STE 2159
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145-3438
Country	:	US
Telephone Number	:	786-301-0670
Fax Number	:

Provider Business Practice Location Address
First Line	:	2520 CORAL WAY STE 2159
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145-3438
Country	:	US
Telephone Number	:	786-301-0670
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VIOLETA OTERO
Credential	:
Telephone Number	:	786-301-0670

Provider Enumeration Date	:	12/23/2014
Last Update Date	:	12/23/2014

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