Provider Demographics
NPI:1518582295
Name:DOMINGUEZ BAUTE CORP
Entity Type:Organization
Organization Name:DOMINGUEZ BAUTE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ILEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGUEZ BAUTE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:786-419-0994
Mailing Address - Street 1:14707 S DIXIE HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7950
Mailing Address - Country:US
Mailing Address - Phone:786-250-3475
Mailing Address - Fax:786-364-7348
Practice Address - Street 1:14707 S DIXIE HWY STE 201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-7950
Practice Address - Country:US
Practice Address - Phone:786-250-3475
Practice Address - Fax:786-364-7348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-09
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty