Provider Demographics
NPI:1902870397
Name:SALIBA, DOMINIQUE B (MD)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:B
Last Name:SALIBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 W ATLANTIC BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-6048
Mailing Address - Country:US
Mailing Address - Phone:954-781-3122
Mailing Address - Fax:954-781-0860
Practice Address - Street 1:321 W ATLANTIC BLVD STE 102
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-6048
Practice Address - Country:US
Practice Address - Phone:954-781-3122
Practice Address - Fax:954-781-0860
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76236207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255139000Medicaid
FLE2371YMedicare UPIN
G90256Medicare UPIN