Provider Demographics
NPI:1053821348
Name:DORSAL MEDICAL PROFESSIONALS LLC
Entity Type:Organization
Organization Name:DORSAL MEDICAL PROFESSIONALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:OPORTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-552-7660
Mailing Address - Street 1:3901 NW 79TH AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6554
Mailing Address - Country:US
Mailing Address - Phone:305-552-7660
Mailing Address - Fax:305-552-7662
Practice Address - Street 1:3901 NW 79TH AVE STE 129
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6554
Practice Address - Country:US
Practice Address - Phone:305-552-7660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME125615207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty