Organization
DOMINGUEZ BAUTE CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ILEANA DOMINGUEZ BAUTE APRN (PRESIDENT)
(786) 419-0994
Entity
Organization
Contact information
Practice address
14707 S DIXIE HWY STE 201, MIAMI, FL 33176-7950
(786) 250-3475
(786) 364-7348
Mailing address
14707 S DIXIE HWY STE 201, MIAMI, FL 33176-7950
(786) 250-3475
(786) 364-7348
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
06/09/2020
Last updated
05/10/2024
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