Healthcare Provider Details

I. General information

NPI: 1114354073
Provider Name (Legal Business Name): DORAL COMMUNITY CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2013
Last Update Date: 10/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 NW 25TH ST SUITE 106
DORAL FL
33172-1508
US

IV. Provider business mailing address

9300 NW 25TH ST SUITE 106
DORAL FL
33172-1508
US

V. Phone/Fax

Practice location:
  • Phone: 305-498-9898
  • Fax:
Mailing address:
  • Phone: 305-498-9898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RICARDO MARTINEZ
Title or Position: CEO
Credential: MD
Phone: 305-498-9898