MEDICARE: MANUEL DOMINGUEZ MD PA

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
1	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922672294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANUEL DOMINGUEZ MD PA

Provider Business Mailing Address
First Line	:	1540 WASHINGTON AVE
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-7801
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1540 WASHINGTON AVE
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-7801
Country	:	US
Telephone Number	:	305-532-4122
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MANUEL DOMINGUEZ
Credential	:	MD
Telephone Number	:	305-532-4122

Provider Enumeration Date	:	05/19/2021
Last Update Date	:	06/22/2021

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