=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083946883
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAB PROFESSIONAL CARE, CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2010
-----------------------------------------------------
Last Update Date | 07/27/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10300 SW 72ND ST STE 440
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33173-3012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-279-1488
-----------------------------------------------------
Fax | 305-279-1498
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10300 SW 72ND ST STE 440
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33173-3012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-279-1488
-----------------------------------------------------
Fax | 305-279-1498
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ARMANDO BERNAL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-279-1498
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | HCC 7671
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------