Healthcare Provider Details

I. General information

NPI: 1740557024
Provider Name (Legal Business Name): DG SERVICES PROFESSIONAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2955 NE 190TH ST #101
AVENTURA FL
33180-4912
US

IV. Provider business mailing address

PO BOX 650544
MIAMI FL
33265-0544
US

V. Phone/Fax

Practice location:
  • Phone: 786-320-0743
  • Fax:
Mailing address:
  • Phone: 786-320-0743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberMA59040
License Number StateFL

VIII. Authorized Official

Name: MR. DAFNE H SANCHEZ II
Title or Position: OWNER
Credential: MT
Phone: 786-320-0743