Individual
CARLOS LORENZO DOMINGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
1857 PROVIDENCE BLVD, DELTONA, FL 32725-3811
(386) 789-8544
(321) 249-9432
Mailing address
4876 RED BRICK RUN, SANFORD, FL 32771-7108
(386) 789-8544
(321) 249-9432
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME0072352
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
252750200
—
FL
Enumeration date
06/03/2006
Last updated
01/25/2012
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