Provider Demographics
NPI:1780117580
Name:DORAL CANCER INSTITUTE LLC
Entity type:Organization
Organization Name:DORAL CANCER INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-632-2169
Mailing Address - Street 1:1172 S DIXIE HWY
Mailing Address - Street 2:STE 161
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2918
Mailing Address - Country:US
Mailing Address - Phone:305-785-7899
Mailing Address - Fax:786-410-5180
Practice Address - Street 1:3125 NW 84TH AVE
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1994
Practice Address - Country:US
Practice Address - Phone:305-785-7899
Practice Address - Fax:786-410-5180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME121889207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty