Provider Demographics
NPI:1376785220
Name:GOAL SEAL MEDICAL
Entity Type:Organization
Organization Name:GOAL SEAL MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZOILA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBLEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-308-0969
Mailing Address - Street 1:3408 WEST 84 STREET ST 117
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018
Mailing Address - Country:US
Mailing Address - Phone:786-308-0969
Mailing Address - Fax:786-272-0057
Practice Address - Street 1:3408 WEST 84 STREET ST 117
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018
Practice Address - Country:US
Practice Address - Phone:786-308-0969
Practice Address - Fax:786-272-0057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization