Healthcare Provider Details

I. General information

NPI: 1437565611
Provider Name (Legal Business Name): ROMY GRETEL DORADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 NW 79TH AVE
DORAL FL
33166
US

IV. Provider business mailing address

3900 NW 79TH AVE SUITE 501
DORAL FL
33166-6556
US

V. Phone/Fax

Practice location:
  • Phone: 305-597-3861
  • Fax:
Mailing address:
  • Phone: 305-597-3861
  • Fax: 305-597-3863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number25132
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: