Individual provider Active NPI

Paulina Dominguez, P.A

  • Physician Assistant
  • Cutler Bay, FL
National Provider Identifier
1124377353
Registry record updated Dec 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9106727 Issued in FL
Practice address
18557 S Dixie Hwy
Cutler Bay, FL 33157-6845
Phone
(786) 293-9000
Fax
(305) 238-1246
NPI assigned
Sep 4, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9106727 FL Primary

Addresses

Primary practice location

18557 S Dixie Hwy
Cutler Bay, FL 33157-6845

Mailing address

5310 NW 33Rd Ave Ste 216
Fort Lauderdale, FL 33309-6307
Phone (954) 731-9676

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130419000112 FL Practitioner - Physician Assistant 2264678135 Reassigns benefits to 7 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
57073CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Phoenix Emergency Medicine of Broward LLC CurrentSince Jan 15, 2021 Accepting new patients
Ridgewood Emergency Group, LLC Physician Assistant CurrentSince Jan 5, 2020 Accepting new patients
Phoenix Emergency Medicine of Broward LLC CurrentSince Jan 15, 2021 Accepting new patients

Locations

40100 Highway 27
Davenport, FL 33837
Phone (863) 419-2496

1600 S Andrews Ave
Ft Lauderdale, FL 33316
Phone (954) 355-4000

6401 N Federal Hwy
Ft Lauderdale, FL 33308
Phone (954) 776-8500

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575504000000",
    "number": "1124377353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5310 NW 33RD AVE STE 216",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333096307",
            "telephone_number": "954-731-9676",
            "fax_number": "954-731-9747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18557 S DIXIE HWY",
            "city": "CUTLER BAY",
            "state": "FL",
            "postal_code": "331576845",
            "telephone_number": "786-293-9000",
            "fax_number": "305-238-1246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINGUEZ",
        "first_name": "PAULINA",
        "credential": "P.A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-04",
        "last_updated": "2019-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9106727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cutler Bay, FL

Sources for this page

Verify at the official NPI Registry.