Provider Demographics
NPI:1073289005
Name:GOLD STAR MEDICAL LLC
Entity Type:Organization
Organization Name:GOLD STAR MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHID
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHAUDHARY-MIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-673-1238
Mailing Address - Street 1:#184 CALLE VALENCIA
Mailing Address - Street 2:URB. LA SALAMANCA
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683
Mailing Address - Country:US
Mailing Address - Phone:787-673-1238
Mailing Address - Fax:
Practice Address - Street 1:#2 MUNOZ RIVERA
Practice Address - Street 2:BO. PUEBLO
Practice Address - City:HORMIGUEROS
Practice Address - State:PR
Practice Address - Zip Code:00660
Practice Address - Country:US
Practice Address - Phone:787-673-1238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR371248OtherREGISTER NUMBER