Provider Demographics
NPI:1972126399
Name:DORAL SPINE & WELLNESS, INC.
Entity Type:Organization
Organization Name:DORAL SPINE & WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA FUENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-477-7976
Mailing Address - Street 1:8726 NW 26TH ST STE 16
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-1628
Mailing Address - Country:US
Mailing Address - Phone:305-477-7976
Mailing Address - Fax:
Practice Address - Street 1:8726 NW 26TH ST STE 16
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-1628
Practice Address - Country:US
Practice Address - Phone:305-477-7976
Practice Address - Fax:305-629-9187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty