Provider Demographics
NPI:1396436515
Name:DOMAZET, EMIR
Entity type:Individual
Prefix:
First Name:EMIR
Middle Name:
Last Name:DOMAZET
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 OAK PARK DR S
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-6437
Mailing Address - Country:US
Mailing Address - Phone:727-656-8725
Mailing Address - Fax:
Practice Address - Street 1:1890 OAK PARK DR S
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764-6437
Practice Address - Country:US
Practice Address - Phone:727-656-8725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities