Provider Demographics
NPI:1265066237
Name:GOLDEN MEDICAL CENTER II
Entity type:Organization
Organization Name:GOLDEN MEDICAL CENTER II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:PALACIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-904-0616
Mailing Address - Street 1:818 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-4564
Mailing Address - Country:US
Mailing Address - Phone:407-201-5202
Mailing Address - Fax:407-201-5047
Practice Address - Street 1:818 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4564
Practice Address - Country:US
Practice Address - Phone:407-201-5202
Practice Address - Fax:407-201-5047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD620795765180OtherDRIVERS LICENSE