Healthcare Provider Details

I. General information

NPI: 1447282900
Provider Name (Legal Business Name): DORAL MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 W 16TH AVE STE 108
HIALEAH FL
33012-4654
US

IV. Provider business mailing address

3750 W 16TH AVE STE 108
HIALEAH FL
33012-4654
US

V. Phone/Fax

Practice location:
  • Phone: 305-512-0327
  • Fax: 305-512-0328
Mailing address:
  • Phone: 305-512-0327
  • Fax: 305-512-0328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberHCC 6046
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANTONIO CANTOS
Title or Position: PRESIDENT
Credential:
Phone: 305-512-0327