=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003560053
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID ENTERPRISES GROUP INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2022
-----------------------------------------------------
Last Update Date | 02/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3785 NW 82ND AVE STE 209
-----------------------------------------------------
City | DORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33166-6630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-576-2576
-----------------------------------------------------
Fax | 352-204-1970
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1155 WILDMEADOW RUN
-----------------------------------------------------
City | WINTER PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32792-3036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-545-6132
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL AND BIOCHEMICAL GENETICIST
-----------------------------------------------------
Name | DR. MARGARITA P NIETO MORENO
-----------------------------------------------------
Credential | MD, MBA.
-----------------------------------------------------
Telephone | 786-545-6132
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QG0250X
-----------------------------------------------------
Taxonomy Name | Genetics Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------