Provider Demographics
NPI:1225335698
Name:ALBERTO DOMINGUEZ-BALI MDPA
Entity Type:Organization
Organization Name:ALBERTO DOMINGUEZ-BALI MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGUEZ-BALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-693-3535
Mailing Address - Street 1:777 E 25TH ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3825
Mailing Address - Country:US
Mailing Address - Phone:305-693-3535
Mailing Address - Fax:305-693-3565
Practice Address - Street 1:777 E 25TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3825
Practice Address - Country:US
Practice Address - Phone:305-693-3535
Practice Address - Fax:305-693-3565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79533207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260195800Medicaid
FLE4973Medicare PIN
FLH29804Medicare UPIN