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General NPI Number Information
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NPI Number | 1417900994
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Entity Type | Organization
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Legal Business Name | GABRIEL DOMENECH MD PA
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 201 NW 82ND AVE STE 201
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City | PLANTATION
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State | FL
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Zip | 33324-1854
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Country | US
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Telephone | 954-314-7100
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Fax | 954-324-7133
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Provider Business Mailing Address
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Address Line | 1515 WINDJAMMER WAY
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City | HOLLYWOOD
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State | FL
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Zip | 33019-5035
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Country | US
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Telephone | 954-253-3114
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Fax | 954-961-9282
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Authorized Official
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Title or Position | OWNER
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Name | GABRIEL DOMENECH
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Credential | M.D.
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Telephone | 954-253-3114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | ME 78342
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License Number State | FL
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