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General NPI Number Information
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NPI Number | 1518855931
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICAL GROUP DORAL LLC
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Dates
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Enumeration Date | 06/25/2025
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 3470 NW 82ND AVE STE 110
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City | DORAL
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State | FL
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Zip | 33122-1026
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Country | US
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Telephone | 305-504-6044
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Fax | 305-707-3576
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Provider Business Mailing Address
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Address Line | 12391 SW 130TH ST
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City | MIAMI
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State | FL
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Zip | 33186-6208
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Country | US
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Telephone | 305-504-6044
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ILEANA COLLADO
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Credential |
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Telephone | 305-504-6044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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