=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902971039
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DORAL MEDICAL SUPPLY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7225 NW 25TH ST SUITE 113
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33122-1706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-599-9636
-----------------------------------------------------
Fax | 305-599-5295
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7225 NW 25TH ST SUITE 113
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33122-1706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-599-9636
-----------------------------------------------------
Fax | 305-599-5295
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. LUISA MARIA MISHAAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-599-9636
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 1313168
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------