Healthcare Provider Details

I. General information

NPI: 1104596105
Provider Name (Legal Business Name): D AND L COMMUNITY SUPPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14722 SW 56TH ST
MIAMI FL
33185-4041
US

IV. Provider business mailing address

14722 SW 56TH ST
MIAMI FL
33185-4041
US

V. Phone/Fax

Practice location:
  • Phone: 305-456-0572
  • Fax: 786-980-5700
Mailing address:
  • Phone: 305-456-0572
  • Fax: 786-980-5700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DORGIS GONZALEZ REINOSO
Title or Position: PRESIDENT
Credential:
Phone: 786-424-9440