Individual
TEDDY J DORIVAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12600 NW 19TH AVE, MIAMI, FL 33167-2159
(305) 842-0171
Mailing address
12600 NW 19TH AVE, MIAMI, FL 33167-2159
(305) 842-0171
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
001732-P.A.
PR
363AM0700X
Medical Physician Assistant
10019
AZ
363AM0700X
Medical Physician Assistant
PACN140
FL
Other
Enumeration date
07/17/2023
Last updated
03/06/2026
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