Provider Demographics
NPI:1194998062
Name:DORAL SURGICAL SERVICES
Entity type:Organization
Organization Name:DORAL SURGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MAXIMO
Authorized Official - Middle Name:R
Authorized Official - Last Name:TIRADOR
Authorized Official - Suffix:
Authorized Official - Credentials:SAC
Authorized Official - Phone:305-905-7628
Mailing Address - Street 1:6440 NW 114TH AVE UNIT 405
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-4572
Mailing Address - Country:US
Mailing Address - Phone:305-905-7628
Mailing Address - Fax:786-431-1078
Practice Address - Street 1:6440 NW 114TH AVE UNIT 405
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4572
Practice Address - Country:US
Practice Address - Phone:305-905-7628
Practice Address - Fax:786-431-1078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty