Provider Demographics
NPI:1619795143
Name:DORADO NICO, ANDRES M (PA)
Entity type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:M
Last Name:DORADO NICO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:6340 SW 149TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-2796
Mailing Address - Country:US
Mailing Address - Phone:786-412-5731
Mailing Address - Fax:305-274-5320
Practice Address - Street 1:9495 SW 72ND ST STE B180
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5424
Practice Address - Country:US
Practice Address - Phone:305-274-5319
Practice Address - Fax:305-274-5320
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-392034106S00000X
PR2305363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty