Provider Demographics
NPI:1598703993
Name:DOMINGUEZ MEDICAL CENTER CORP
Entity Type:Organization
Organization Name:DOMINGUEZ MEDICAL CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:C
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-319-1381
Mailing Address - Street 1:330 E 9TH ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4221
Mailing Address - Country:US
Mailing Address - Phone:786-319-1381
Mailing Address - Fax:305-805-8566
Practice Address - Street 1:330 E 9TH ST
Practice Address - Street 2:SUITE 206
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4221
Practice Address - Country:US
Practice Address - Phone:786-319-1381
Practice Address - Fax:305-805-8566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL603270-0261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center