Healthcare Provider Details

I. General information

NPI: 1689659815
Provider Name (Legal Business Name): DORREL SMALL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9370 SUNSET DR SUITE A-250
MIAMI FL
33173-5431
US

IV. Provider business mailing address

6441 OLDE MOAT WAY
DAVIE FL
33331-3433
US

V. Phone/Fax

Practice location:
  • Phone: 305-595-4510
  • Fax:
Mailing address:
  • Phone: 954-434-2900
  • Fax: 954-434-2900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP1662342
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: