Healthcare Provider Details

I. General information

NPI: 1245696954
Provider Name (Legal Business Name): GABRIEL DOMINGUEZ-CONTRERAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2563 SWEET VIBURNUM WAY
OCOEE FL
34761-5347
US

IV. Provider business mailing address

225 N MICHIGAN AVE STE 1430
CHICAGO IL
60601-7653
US

V. Phone/Fax

Practice location:
  • Phone: 407-864-1301
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: