Provider Demographics
NPI:1134203599
Name:DOMINGUEZ, OSCAR JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:JOSEPH
Last Name:DOMINGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8352 SW 40TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3354
Mailing Address - Country:US
Mailing Address - Phone:305-390-2729
Mailing Address - Fax:305-273-7960
Practice Address - Street 1:8352 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3354
Practice Address - Country:US
Practice Address - Phone:305-390-2729
Practice Address - Fax:305-676-6628
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85157207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH81035Medicare UPIN