| Organization Name: | HUMBERTO A DOMINGUEZ MD PA |
| NPI Number: | 1144538364 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | HUMBERTO A DOMINGUEZ (OWNER) |
| Mailing Address: | 70 Fox Ridge Ct Suite A Debary |
| State: | FL US |
| Postal Code: | 327132752 |
| Phone Number: | 3866684411 |
| Fax Number: | 3866688688 |
| NPI Enumeration Date: | 09/22/2010 |
| NPI Last Update Date: | 06/20/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | ME29577 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |