Provider Demographics
NPI:1528654860
Name:LA EDAD DORADA CORP
Entity type:Organization
Organization Name:LA EDAD DORADA CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAVERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-553-2717
Mailing Address - Street 1:1071 NW 119TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33168-6240
Mailing Address - Country:US
Mailing Address - Phone:786-803-8271
Mailing Address - Fax:786-803-8291
Practice Address - Street 1:1071 NW 119TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33168-6240
Practice Address - Country:US
Practice Address - Phone:786-803-8271
Practice Address - Fax:786-803-8291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-20
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care