Provider Demographics
NPI:1720453855
Name:DORAL RELIEF MEDICAL CENTER
Entity Type:Organization
Organization Name:DORAL RELIEF MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-534-5112
Mailing Address - Street 1:3900 NW 79TH AVE STE 559
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6562
Mailing Address - Country:US
Mailing Address - Phone:786-534-5112
Mailing Address - Fax:786-502-8131
Practice Address - Street 1:3900 NW 79TH AVE STE 559
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6562
Practice Address - Country:US
Practice Address - Phone:786-534-5112
Practice Address - Fax:786-502-8131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC10469261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center