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: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W ATLANTIC BLVD
POMPANO BEACH FL
33060-5916
US

IV. Provider business mailing address

1608 SE 3RD AVE FL 3
FORT LAUDERDALE FL
33316-2564
US

V. Phone/Fax

Practice location:
  • Phone: 954-785-4273
  • Fax: 954-784-9249
Mailing address:
  • Phone: 954-785-4273
  • Fax: 954-784-9249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: