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General NPI Number Information
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NPI Number | 1487578043
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Entity Type | Individual
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Provider Name | DR. JORGE ANDRES DOMINGUEZ
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Gender | Male
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Dates
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Enumeration Date | 08/06/2026
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Last Update Date | 08/06/2026
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Provider Practice Location Address
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Address Line | 9767 SW 72ND ST
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City | MIAMI
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State | FL
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Zip | 33173-4615
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Country | US
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Telephone | 786-785-8990
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Fax |
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Provider Business Mailing Address
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Address Line | 15528 SW 172ND TER
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City | MIAMI
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State | FL
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Zip | 33187-1360
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Country | US
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Telephone | 305-527-0599
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Fax |
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | PT45096
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License Number State | FL
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