Organization
CARLOS L DOMINGUEZ MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARLOS L DOMINGUEZ MD (OWNER/PRESIDENT)
(386) 789-8544
Entity
Organization
Contact information
Practice address
1857 PROVIDENCE BLVD, DELTONA, FL 32725-3811
(386) 789-8544
(386) 951-4809
Mailing address
1857 PROVIDENCE BLVD, DELTONA, FL 32725-3811
(386) 789-8544
(386) 951-4809
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
02/20/2012
Last updated
02/20/2012
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