Healthcare Provider Details

I. General information

NPI: 1619532942
Provider Name (Legal Business Name): ALEJANDRO DOMINGUEZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date: 05/10/2019
Reactivation Date: 05/22/2019

III. Provider practice location address

11760 SW 40TH ST STE 606
MIAMI FL
33175-8105
US

IV. Provider business mailing address

11760 SW 40TH ST STE 606
MIAMI FL
33175-8105
US

V. Phone/Fax

Practice location:
  • Phone: 305-564-6424
  • Fax: 305-564-6425
Mailing address:
  • Phone: 305-564-6424
  • Fax: 305-564-6425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberOS18345
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberOS18345
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: