Healthcare Provider Details

I. General information

NPI: 1003736695
Provider Name (Legal Business Name): DARLOZ PROFESSIONAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 IVES DAIRY RD STE 113
MIAMI FL
33179-2537
US

IV. Provider business mailing address

9610 ENCINO ST
MIRAMAR FL
33025-4257
US

V. Phone/Fax

Practice location:
  • Phone: 954-436-8036
  • Fax:
Mailing address:
  • Phone: 954-436-8036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TANISHA D DAWKINS
Title or Position: OWNER
Credential: DAWKINS
Phone: 786-443-2173