Provider Demographics
NPI:1700836178
Name:DA MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:DA MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESSIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:PERERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-820-6533
Mailing Address - Street 1:5789 NW 151 ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014
Mailing Address - Country:US
Mailing Address - Phone:305-820-6533
Mailing Address - Fax:305-820-6534
Practice Address - Street 1:5789 NW 151ST ST
Practice Address - Street 2:SUITE A
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2490
Practice Address - Country:US
Practice Address - Phone:305-820-6533
Practice Address - Fax:305-820-6534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8231Medicare ID - Type UnspecifiedMEDICAL CLINIC