Healthcare Provider Details

I. General information

NPI: 1861286106
Provider Name (Legal Business Name): CARLOS DOMINGUEZ DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4777 E GALBRAITH RD
CINCINNATI OH
45236-2725
US

IV. Provider business mailing address

1701 E 12TH ST APT W17Q
CLEVELAND OH
44114-3236
US

V. Phone/Fax

Practice location:
  • Phone: 513-686-3000
  • Fax:
Mailing address:
  • Phone: 816-752-4268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberAPP-000942953
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberAPP-000942953
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: