MEDICARE: IVANI 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
1	183500000X	Pharmacist	PS68152	FL

General Provider Information

NPI Number	:	1700698784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVANI DOMINGUEZ

Provider Business Mailing Address
First Line	:	2021 SW 100TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-7531
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2021 SW 100TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-7531
Country	:	US
Telephone Number	:	786-400-4968
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2025
Last Update Date	:	01/25/2025

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Directions to “ IVANI DOMINGUEZ ” Practice Location

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