Provider Demographics
NPI:1669929592
Name:GOLDEN MOBILE MEDICAL MANAGEMENT INC
Entity type:Organization
Organization Name:GOLDEN MOBILE MEDICAL MANAGEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:PROSTKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-223-6410
Mailing Address - Street 1:958 SW MARTIN DOWNS BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-2816
Mailing Address - Country:US
Mailing Address - Phone:772-223-6410
Mailing Address - Fax:772-223-0092
Practice Address - Street 1:958 SW MARTIN DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-2816
Practice Address - Country:US
Practice Address - Phone:772-223-6410
Practice Address - Fax:772-223-0092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME52247207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty