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1619795143 NPI number — ANDRES MANUEL DORADO NICO PA

NPI Number: 1619795143
Health Care Provider/Practitioner: ANDRES MANUEL DORADO NICO PA

Information about “1619795143” NPI (ANDRES MANUEL DORADO NICO PA) exists in 1619795143 in HTML format HTML  |  1619795143 in plain Text format TXT  |  1619795143 in PDF (Portable Document Format) PDF  |  1619795143 in an XML format XML  formats.

NPI Number : 1619795143 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1619795143",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DORADO NICO",
    "FirstName": "ANDRES",
    "MiddleName": "MANUEL",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6340 SW 149TH CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MIAMI",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33193-2796",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "786-412-5731",
    "MailingAddressFaxNumber": "305-274-5320",
    "FirstLinePracticeLocationAddress": "974 OLD DIXIE HWY STE A",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HOMESTEAD",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33030-4933",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "305-845-1655",
    "PracticeLocationAddressFaxNumber": "305-845-1641",
    "EnumerationDate": "10/02/2024",
    "LastUpdateDate": "08/01/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "106S00000X",
          "TaxonomyName": "Behavior Technician",
          "LicenseNumber": "RBT-24-392034",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363AM0700X",
          "TaxonomyName": "Medical Physician Assistant",
          "LicenseNumber": "2305",
          "LicenseNumberStateCode": "PR",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363AM0700X",
          "TaxonomyName": "Medical Physician Assistant",
          "LicenseNumber": "PACN72",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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