Individual
GABRIEL DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6000 LAKE ELLENOR DR, ORLANDO, FL 32809-4615
(407) 636-6196
Mailing address
6000 LAKE ELLENOR DR, ORLANDO, FL 32809-4615
(407) 636-6196
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042622756
CCA
MA
01
—
1134107113
MBHP
MA
01
—
12529
HNE
MA
05
—
1307576
—
MA
01
—
71756
TUFTS
MA
01
—
997303
NETWORK HEALTH
MA
Enumeration date
01/11/2016
Last updated
10/26/2020
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