Provider Demographics
NPI:1114354073
Name:DORAL COMMUNITY CLINIC INC
Entity Type:Organization
Organization Name:DORAL COMMUNITY CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-498-9898
Mailing Address - Street 1:9300 NW 25TH ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-1508
Mailing Address - Country:US
Mailing Address - Phone:305-498-9898
Mailing Address - Fax:
Practice Address - Street 1:9300 NW 25TH ST
Practice Address - Street 2:SUITE 106
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-1508
Practice Address - Country:US
Practice Address - Phone:305-498-9898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-08
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service