Provider Demographics
NPI:1174961833
Name:DOCTORS ALLIANCE GROUP
Entity type:Organization
Organization Name:DOCTORS ALLIANCE GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO & PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:ISAAC
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MBA
Authorized Official - Phone:305-695-0644
Mailing Address - Street 1:400 W 41ST ST
Mailing Address - Street 2:201
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3516
Mailing Address - Country:US
Mailing Address - Phone:305-695-0644
Mailing Address - Fax:305-532-1612
Practice Address - Street 1:400 W 41ST ST
Practice Address - Street 2:103
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3516
Practice Address - Country:US
Practice Address - Phone:305-695-0644
Practice Address - Fax:305-532-1612
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOCTORS ALLIANCE GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262022700Medicaid
FLK4388Medicare UPIN