Provider Demographics
NPI:1942847496
Name:ATLANTIC MEDICAL CENTER DORAL INC
Entity Type:Organization
Organization Name:ATLANTIC MEDICAL CENTER DORAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-804-9521
Mailing Address - Street 1:10900 NW 25TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-1922
Mailing Address - Country:US
Mailing Address - Phone:786-804-9521
Mailing Address - Fax:305-716-9254
Practice Address - Street 1:10900 NW 25TH ST STE 104
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-1922
Practice Address - Country:US
Practice Address - Phone:786-804-9521
Practice Address - Fax:305-716-9254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center