Healthcare Provider Details

I. General information

NPI: 1598908188
Provider Name (Legal Business Name): CEILA M. DOMINGUEZ-VERRET M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2009
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 WEST CAMINO REAL SUITE 122
BOCA RATON FL
33433
US

IV. Provider business mailing address

7100 WEST CAMINO REAL SUITE 122
BOCA RATON FL
33433
US

V. Phone/Fax

Practice location:
  • Phone: 561-362-4330
  • Fax: 561-362-4307
Mailing address:
  • Phone: 561-362-4330
  • Fax: 561-362-4307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number264339-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberME104055
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME104055
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: