Individual
ELIDES DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CACII
Contact information
Practice address
2607 WINDGUARD CIR STE 102, WESLEY CHAPEL, FL 33544-7352
(813) 907-6767
(813) 907-1911
Mailing address
5626 CURRY FORD RD, ORLANDO, FL 32822-1424
(407) 985-5677
(844) 388-6186
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
ACN1111
FL
Other
Enumeration date
05/23/2016
Last updated
08/11/2022
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