Provider Demographics
NPI:1902933724
Name:OSCAR J DOMINGUEZ M.D. P.A,
Entity Type:Organization
Organization Name:OSCAR J DOMINGUEZ M.D. P.A,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:J
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-629-2669
Mailing Address - Street 1:8600 SW 92ND ST STE 202
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7377
Mailing Address - Country:US
Mailing Address - Phone:305-629-2669
Mailing Address - Fax:305-981-2095
Practice Address - Street 1:8600 SW 92ND ST STE 202
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7377
Practice Address - Country:US
Practice Address - Phone:305-629-2669
Practice Address - Fax:305-981-2095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85157207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH81035Medicare UPIN
62855AMedicare ID - Type Unspecified