Provider Demographics
NPI:1740557024
Name:DG SERVICES PROFESSIONAL
Entity Type:Organization
Organization Name:DG SERVICES PROFESSIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAFNE
Authorized Official - Middle Name:H
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:II
Authorized Official - Credentials:MT
Authorized Official - Phone:786-320-0743
Mailing Address - Street 1:PO BOX 650544
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33265-0544
Mailing Address - Country:US
Mailing Address - Phone:786-320-0743
Mailing Address - Fax:
Practice Address - Street 1:2955 NE 190TH ST
Practice Address - Street 2:#101
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-4912
Practice Address - Country:US
Practice Address - Phone:786-320-0743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA59040261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation