Provider Demographics
NPI:1093031049
Name:DORAMED MEDICAL OFFICE
Entity Type:Organization
Organization Name:DORAMED MEDICAL OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR IN MEDICINE/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ODELSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-870-2938
Mailing Address - Street 1:RR 6 BOX 7446
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:787-870-2938
Mailing Address - Fax:787-870-2938
Practice Address - Street 1:CARR. 165 KM 4.0 BO. QUEBRADA CRUZ
Practice Address - Street 2:
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-870-2938
Practice Address - Fax:787-870-2938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty