Healthcare Provider Details

I. General information

NPI: 1659477263
Provider Name (Legal Business Name): DOS OF HIALEAH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8785 NW 32ND AVE
MIAMI FL
33147-3705
US

IV. Provider business mailing address

8785 NW 32ND AVE
MIAMI FL
33147-3705
US

V. Phone/Fax

Practice location:
  • Phone: 305-691-5711
  • Fax: 305-691-6707
Mailing address:
  • Phone: 305-691-5711
  • Fax: 305-691-6707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF1399096
License Number StateFL

VIII. Authorized Official

Name: MR. JORGE R HERNANDO
Title or Position: OWNER
Credential:
Phone: 305-868-1830