Provider Demographics
NPI:1730134511
Name:DORAL MEDICAL OFFICE CORP
Entity Type:Organization
Organization Name:DORAL MEDICAL OFFICE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-471-9524
Mailing Address - Street 1:4005 NW 114TH AVE
Mailing Address - Street 2:SUITE 22
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-4374
Mailing Address - Country:US
Mailing Address - Phone:305-471-9524
Mailing Address - Fax:305-471-9433
Practice Address - Street 1:4005 NW 114TH AVE
Practice Address - Street 2:SUITE 22
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4374
Practice Address - Country:US
Practice Address - Phone:305-471-9524
Practice Address - Fax:305-471-9433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9518Medicare ID - Type UnspecifiedPART B