Provider Demographics
NPI:1811409352
Name:DORAL CARDIOLOGY, INC.,
Entity Type:Organization
Organization Name:DORAL CARDIOLOGY, INC.,
Other - Org Name:DORAL CARDIOLOGY, INC.,
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:BERNARDO
Authorized Official - Last Name:VAZQUEZ-TANUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-403-1035
Mailing Address - Street 1:9851 NW 58TH ST UNIT 125
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2718
Mailing Address - Country:US
Mailing Address - Phone:305-403-1035
Mailing Address - Fax:305-403-1036
Practice Address - Street 1:9851 NW 58TH ST UNIT 125
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2718
Practice Address - Country:US
Practice Address - Phone:305-403-1035
Practice Address - Fax:305-403-1036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN840207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty