Healthcare Provider Details

I. General information

NPI: 1194998062
Provider Name (Legal Business Name): DORAL SURGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6440 NW 114TH AVE UNIT 405
DORAL FL
33178-4572
US

IV. Provider business mailing address

6440 NW 114TH AVE UNIT 405
DORAL FL
33178-4572
US

V. Phone/Fax

Practice location:
  • Phone: 305-905-7628
  • Fax: 786-431-1078
Mailing address:
  • Phone: 305-905-7628
  • Fax: 786-431-1078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MAXIMO R TIRADOR
Title or Position: PRESIDENT
Credential: SAC
Phone: 305-905-7628