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Organization
EASTERN MEDICAL FORT MEYERS
Active
Organization
EASTERN MEDICAL FORT MEYERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTIAN S DOMINGUEZ (C.E.O)
(305) 901-9551
Entity
Organization
Contact information
Practice address
8900 SW 24 ST #202, MIAMI, FL 33165
(305) 901-9551
(786) 618-5219
Mailing address
8900 SW 24 ST #202, MIAMI, FL 33165
(305) 901-9551
(786) 618-5219
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
—
—
Other
Enumeration date
02/03/2021
Last updated
02/03/2021
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