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NPI Code Detail

MEDICARE: DOMINGUEZ HEALTH CARE LLC

MEDICARE: DOMINGUEZ HEALTH CARE LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner

General Provider Information

NPI Number : 1568317972
Entity Type Code : Organization
Provider Name (Legal Business Name) : DOMINGUEZ HEALTH CARE LLC
Provider Business Mailing Address
First Line : 5471 W 10TH LN
Second Line :
City : HIALEAH
State : FL
Zip : 33012-2463
Country : US
Telephone Number : 786-414-4791
Fax Number :
Provider Business Practice Location Address
First Line : 5471 W 10TH LN
Second Line :
City : HIALEAH
State : FL
Zip : 33012-2463
Country : US
Telephone Number : 786-414-4791
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MARISELA DOMINGUEZ
Credential : APRN
Telephone Number : 786-414-4791
Provider Enumeration Date : 03/02/2026
Last Update Date : 03/02/2026

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Directions to “DOMINGUEZ HEALTH CARE LLC ” Practice Location

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