Provider Demographics
NPI:1619532942
Name:DOMINGUEZ, ALEJANDRO (DO)
Entity Type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15211 FINTRY PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1424
Mailing Address - Country:US
Mailing Address - Phone:786-348-8803
Mailing Address - Fax:
Practice Address - Street 1:2001 W 68TH ST STE 202
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1801
Practice Address - Country:US
Practice Address - Phone:305-364-2107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2019-05-22
Deactivation Date:2019-05-10
Deactivation Code:
Reactivation Date:2019-05-22
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program