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NPI Code Detail

MEDICARE: EDDY DOMINGUEZ APRN

MEDICARE: EDDY DOMINGUEZ APRN
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
1363LF0000XFamily Nurse Practitioner11004646FL

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 : 1609042878
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDDY DOMINGUEZ APRN
Provider Business Mailing Address
First Line : 2735 W 52ND ST APT 103
Second Line :
City : HIALEAH
State : FL
Zip : 33016-4771
Country : US
Telephone Number : 786-290-3277
Fax Number : 305-757-4465
Provider Business Practice Location Address
First Line : 4175 W 20TH AVE
Second Line :
City : HIALEAH
State : FL
Zip : 33012-5874
Country : US
Telephone Number : 305-825-0300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2008
Last Update Date : 12/11/2020

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