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General NPI Number Information
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NPI Number | 1366953895
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Entity Type | Organization
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Legal Business Name | DOMINGUEZ COMMUNITY CENTER CORP.
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Dates
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Enumeration Date | 10/24/2017
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 13205 SW 137TH AVE STE 132
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City | MIAMI
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State | FL
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Zip | 33186-5334
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Country | US
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Telephone | 786-478-6369
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Fax | 786-429-1704
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Provider Business Mailing Address
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Address Line | 13205 SW 137TH AVE STE 132
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City | MIAMI
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State | FL
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Zip | 33186-5334
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Country | US
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Telephone | 786-478-6369
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Fax | 786-429-1704
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ADANNYS DOMINGUEZ
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Credential |
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Telephone | 305-744-4525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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