Individual
JOSE CARLOS DOMINGUEZ JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3645 MADACA LN, TAMPA, FL 33618-2048
(813) 969-0116
(813) 969-3794
Mailing address
3645 MADACA LN, TAMPA, FL 33618-2048
(813) 969-0116
(813) 969-3794
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
ME00555091
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
059950600
—
FL
Enumeration date
03/30/2006
Last updated
10/26/2011
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