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Individual

DR. ROBERTO V DOMINGUEZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2914 N BOULEVARD, TAMPA, FL 33602-1208
(813) 228-7696
(813) 228-0677
Mailing address
2914 N BOULEVARD, TAMPA, FL 33602-1208
(813) 228-7696
(813) 228-0677

Taxonomy

Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
ME0070106
FL
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
ME0070106
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2305989
UNITED HEALTHCARE
FL
05
2513081-00
FL
01
2755877
AETNA
FL
01
32985
BLUE CROSS
FL
01
4333872005
CIGNA
FL
01
B217748
WELLCARE (NON-PAR)
FL
Enumeration date
04/26/2006
Last updated
10/28/2011
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