Healthcare Provider Details

I. General information

NPI: 1710493739
Provider Name (Legal Business Name): YASMANY DOMINGUEZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9955 SE FEDERAL HWY STE B
HOBE SOUND FL
33455-4800
US

IV. Provider business mailing address

13901 US HIGHWAY 1 STE 5
JUNO BEACH FL
33408-1612
US

V. Phone/Fax

Practice location:
  • Phone: 772-212-2656
  • Fax:
Mailing address:
  • Phone: 561-491-4666
  • Fax: 561-630-0312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberUO5588
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS15998
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberUO5588
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberUO5588
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: