Provider Demographics
NPI:1891118105
Name:DORAL CLINIC INC
Entity Type:Organization
Organization Name:DORAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAVO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-694-9802
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:305-694-9802
Mailing Address - Fax:305-639-8271
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:305-694-9802
Practice Address - Fax:305-639-8271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110036261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME110036OtherMEDICAL LICENSE