MEDICARE: LOS ANOS DORADOS INC

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	310400000X	Assisted Living Facility	11958	FL

General Provider Information

NPI Number	:	1649691585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOS ANOS DORADOS INC

Provider Business Mailing Address
First Line	:	11461 SW 214TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33189-2715
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11461 SW 214TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33189-2715
Country	:	US
Telephone Number	:	305-254-8108
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	RAFAEL GARCIA
Credential	:
Telephone Number	:	305-254-8108

Provider Enumeration Date	:	12/19/2013
Last Update Date	:	12/19/2013

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Directions to “LOS ANOS DORADOS INC ” Practice Location

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