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General NPI Number Information
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NPI Number | 1093862377
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Entity Type | Individual
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Provider Name | DOMINIQUE JULIE HERIVEAUX R.N.
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Gender | Female
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10201 HAMMOCKS BLVD # 470 SUITE 153
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City | MIAMI
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State | FL
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Zip | 33196-4712
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Country | US
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Telephone | 786-488-5955
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Fax | 305-380-0756
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Provider Business Mailing Address
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Address Line | 10201 HAMMOCKS BLVD # 470 SUITE 153
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City | MIAMI
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State | FL
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Zip | 33196-4712
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Country | US
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Telephone | 786-488-5955
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Fax | 305-380-0756
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 45010
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License Number State | FL
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