Healthcare Provider Details

I. General information

NPI: 1356646228
Provider Name (Legal Business Name): PORTA DEL SOL SURGICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2011
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 NW 82ND AVE SUITE 201
DORAL FL
33166-6658
US

IV. Provider business mailing address

3650 NW 82ND AVE SUITE 201
DORAL FL
33166-6658
US

V. Phone/Fax

Practice location:
  • Phone: 305-537-7272
  • Fax: 305-537-7274
Mailing address:
  • Phone: 305-537-7272
  • Fax: 305-537-7274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: GREGORIO CABAN
Title or Position: PRESIDENT
Credential: DPM
Phone: 305-537-7272