Provider Demographics
NPI:1679357701
Name:DOMINGUEZ AGUILAR, ROCIO (MHSC, PA-C)
Entity Type:Individual
Prefix:
First Name:ROCIO
Middle Name:
Last Name:DOMINGUEZ AGUILAR
Suffix:
Gender:F
Credentials:MHSC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14412 SW 46TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6834
Mailing Address - Country:US
Mailing Address - Phone:786-245-9446
Mailing Address - Fax:
Practice Address - Street 1:390 N COURTENAY PKWY
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-3456
Practice Address - Country:US
Practice Address - Phone:321-633-3162
Practice Address - Fax:321-821-4955
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9117750363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant