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General NPI Number Information
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NPI Number | 1558164582
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Entity Type | Organization
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Legal Business Name | MAR CORAL GROUP CORP
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Dates
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Enumeration Date | 03/27/2025
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 4711 NW 79TH AVE STE 12L
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City | DORAL
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State | FL
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Zip | 33166-5443
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Country | US
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Telephone | 863-451-1472
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Fax |
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Provider Business Mailing Address
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Address Line | 4711 NW 79TH AVE STE 12L
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City | DORAL
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State | FL
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Zip | 33166-5443
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Country | US
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Telephone | 863-451-1472
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CARLOS MIRABAL
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Credential |
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Telephone | 863-451-1472
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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