Provider Demographics
NPI:1457463010
Name:DOMINGUEZ BALI, ALBERTO (MD)
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:
Last Name:DOMINGUEZ BALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19195 MYSTIC POINTE DR
Mailing Address - Street 2:SUITE 2107
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-4502
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 79533207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9366OtherTOTAL HEALTH CHOICE
00670OtherHEALTHSUN
FL58932OtherBLUE CROSS BLUE SHIELD
FL66798OtherVISTA HEALTH PLAN
FL171705OtherHEALTHEASE
FL0637OtherPARTNER CARE PCS
FL273897OtherAVMED HEALTH PLAN
FL36392OtherNEIGHBORHOOD HEALTH PLAN
FL1679532OtherCIGNA
FL171705OtherSTAYWELL/WELLCARE
FL174268OtherJMH
FL220225OtherAMERIGROUP
FL260195800Medicaid
FL2504015OtherAETNA
FLP00250548OtherRAILROAD MEDICARE
FL260195800Medicaid
FL273897OtherAVMED HEALTH PLAN