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General NPI Number Information
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NPI Number | 1669613998
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Entity Type | Organization
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Legal Business Name | JUAN C. DOMINGO, M.D.,P.A.
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Dates
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Enumeration Date | 03/17/2009
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Last Update Date | 03/17/2009
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Provider Practice Location Address
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Address Line | 900 SW PINE ISLAND ROAD UNIT 208
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City | CAPE CORAL
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State | FL
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Zip | 33991-0000
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Country | US
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Telephone | 239-673-9861
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Fax | 239-673-9886
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Provider Business Mailing Address
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Address Line | 900 SW PINE ISLAND ROAD UNIT 208
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City | CAPE CORAL
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State | FL
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Zip | 33991-0000
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Country | US
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Telephone | 239-673-9861
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Fax | 239-673-9886
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Authorized Official
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Title or Position | CEO
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Name | DR. JUAN CARLOS DOMINGO
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Credential | M.D.
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Telephone | 239-673-9861
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME52059
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License Number State | FL
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