Organization
DOMAHN, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MITHO LAROSE AMILCAR PRESIDENT (ADMINSTRATOR)
(941) 235-1500
Entity
Organization
Contact information
Practice address
3109 TAMIAMI TRL, PORT CHARLOTTE, FL 33952-8046
(941) 235-1500
(941) 235-1508
Mailing address
3109 TAMIAMI TRL, PORT CHARLOTTE, FL 33952-8046
(941) 235-1500
(941) 235-1508
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA34283
FL
Other
Enumeration date
11/15/2008
Last updated
11/15/2008
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