Provider Demographics
NPI:1700306099
Name:NINETTE&DAIMIS CORP
Entity Type:Organization
Organization Name:NINETTE&DAIMIS CORP
Other - Org Name:NINETTE&DAIMIS CORP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAIMIS
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ ROSABAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-343-3552
Mailing Address - Street 1:3157 N UNIVERSITY DR STE 103
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-2258
Mailing Address - Country:US
Mailing Address - Phone:954-332-8985
Mailing Address - Fax:954-332-8981
Practice Address - Street 1:3157 N UNIVERSITY DR STE 103
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-2258
Practice Address - Country:US
Practice Address - Phone:954-332-8985
Practice Address - Fax:954-332-8981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN676261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLACN676OtherMD LICENSE