Healthcare Provider Details

I. General information

NPI: 1962543835
Provider Name (Legal Business Name): DANILO THALES DORMEUS RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15300 NE 5TH AVE
MIAMI FL
33162-5052
US

IV. Provider business mailing address

15300 NE 5TH AVE
MIAMI FL
33162-5052
US

V. Phone/Fax

Practice location:
  • Phone: 305-947-9823
  • Fax: 305-987-9823
Mailing address:
  • Phone: 305-947-9823
  • Fax: 305-987-9823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License NumberRT005405
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: