Provider Demographics
NPI:1598262115
Name:DOMINGO CABREJA, GINA CAROLINA (MD)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:CAROLINA
Last Name:DOMINGO CABREJA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 SHAFER CT STE 700
Mailing Address - Street 2:
Mailing Address - City:ROSEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60018-4989
Mailing Address - Country:US
Mailing Address - Phone:346-376-1702
Mailing Address - Fax:224-532-2780
Practice Address - Street 1:1200 S PINE ISLAND RD STE 350
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-4409
Practice Address - Country:US
Practice Address - Phone:305-223-2000
Practice Address - Fax:305-227-5556
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME147267207Q00000X, 207QH0002X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program