Provider Demographics
NPI:1407615719
Name:GOLDEN BAY CENTER INC.
Entity Type:Organization
Organization Name:GOLDEN BAY CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIAZ ROMERO
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:305-962-1005
Mailing Address - Street 1:12950 BISCAYNE BLVD.
Mailing Address - Street 2:422
Mailing Address - City:NORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33181-7951
Mailing Address - Country:US
Mailing Address - Phone:305-962-1005
Mailing Address - Fax:
Practice Address - Street 1:12950 BISCAYNE BLVD.
Practice Address - Street 2:422
Practice Address - City:NORTH
Practice Address - State:FL
Practice Address - Zip Code:33181-7951
Practice Address - Country:US
Practice Address - Phone:305-962-1005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition