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General NPI Number Information
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NPI Number | 1306134762
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Entity Type | Organization
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Legal Business Name | DORAL BEACH OB/GYN, LLC
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Dates
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Enumeration Date | 07/19/2011
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Last Update Date | 07/19/2011
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Provider Practice Location Address
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Address Line | 4302 ALTON RD SUITE #580
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City | MIAMI BEACH
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State | FL
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Zip | 33140-2891
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Country | US
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Telephone | 305-532-1989
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Fax | 305-532-8459
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Provider Business Mailing Address
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Address Line | 4302 ALTON RD SUITE #580
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City | MIAMI BEACH
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State | FL
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Zip | 33140-2891
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Country | US
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Telephone | 305-532-1989
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Fax | 305-532-8459
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Authorized Official
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Title or Position | PRESIDENT
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Name | MELVIN E CASTILLO
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Credential | M.D
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Telephone | 305-532-1989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME27923
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License Number State | FL
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