Healthcare Provider Details

I. General information

NPI: 1245909449
Provider Name (Legal Business Name): EMERGENT PHYSICIANS OF DORAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2021
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9520 NW 58 ST
MIAMI FL
33178
US

IV. Provider business mailing address

PO BOX 162787
ALTAMONTE SPRINGS FL
32716-2787
US

V. Phone/Fax

Practice location:
  • Phone: 786-662-8101
  • Fax:
Mailing address:
  • Phone: 786-888-8820
  • Fax: 786-591-6025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GABRIELA PICADO
Title or Position: OFFICE MANAGER
Credential:
Phone: 786-888-8820