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General NPI Number Information
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NPI Number | 1891831004
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Entity Type | Individual
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Provider Name | MANUEL DOMINGUEZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 09/20/2012
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Provider Practice Location Address
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Address Line | 1540 WASHINGTON AVE
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City | MIAMI BEACH
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State | FL
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Zip | 33139-7801
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Country | US
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Telephone | 305-532-4122
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Fax | 305-534-9665
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Provider Business Mailing Address
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Address Line | 1540 WASHINGTON AVE
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City | MIAMI BEACH
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State | FL
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Zip | 33139-7801
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Country | US
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Telephone | 305-532-4122
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Fax | 305-534-9665
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME0029578
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License Number State | FL
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