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NPI Code Detail

MEDICARE: EVELYN DOMINGUEZ

MEDICARE: EVELYN DOMINGUEZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN9458773FL
2246ZS0410XSurgical Technologist
3363L00000XNurse PractitionerAPRN11014312FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1568444966
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVELYN DOMINGUEZ
Provider Business Mailing Address
First Line : 10131 W. FOREST HILL BLVD
Second Line : STE 230
City : WEST PALM BEACH
State : FL
Zip : 33414
Country : US
Telephone Number : 561-798-6600
Fax Number : 561-204-2042
Provider Business Practice Location Address
First Line : 440 N STATE ROAD 7 STE B
Second Line :
City : ROYAL PALM BEACH
State : FL
Zip : 33411-3504
Country : US
Telephone Number : 561-798-6600
Fax Number : 561-753-3328
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/19/2005
Last Update Date : 07/22/2021

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Directions to “ EVELYN DOMINGUEZ ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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