Healthcare Provider Details

I. General information

NPI: 1528276938
Provider Name (Legal Business Name): DORAL PEDIATRICS P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10723 NW 58TH ST
DORAL FL
33178-2801
US

IV. Provider business mailing address

10723 NW 58TH ST
DORAL FL
33178-2801
US

V. Phone/Fax

Practice location:
  • Phone: 305-513-0200
  • Fax: 305-513-4100
Mailing address:
  • Phone: 305-513-0200
  • Fax: 305-513-4100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberME69503
License Number StateFL

VIII. Authorized Official

Name: DR. SILVIA ROSA PEREZ-PASCUAL
Title or Position: PEDIATRICIAN
Credential: M.D.
Phone: 305-513-0200