Humberto a Dominguez MD PA

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

ME29577 Issued in FL

Legal business name

HUMBERTO A DOMINGUEZ MD PA

Practice address

70 Fox Ridge CT
Suite a
Debary, FL 32713-2752

Phone

(386) 668-4411

Fax

(386) 668-8688

NPI assigned

Sep 22, 2010

Organization subpart

No

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

Authorized official

Name

Humberto A Dominguez, MD

Title

Owner

Phone

(386) 668-4411

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1285113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308528000000",
    "number": "1144538364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 FOX RIDGE CT",
            "address_2": "SUITE A",
            "city": "DEBARY",
            "state": "FL",
            "postal_code": "327132752",
            "telephone_number": "386-668-4411",
            "fax_number": "386-668-8688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 FOX RIDGE CT",
            "address_2": "SUITE A",
            "city": "DEBARY",
            "state": "FL",
            "postal_code": "327132752",
            "telephone_number": "386-668-4411",
            "fax_number": "386-668-8688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUMBERTO A DOMINGUEZ MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-22",
        "last_updated": "2011-06-20",
        "status": "A",
        "authorized_official_last_name": "DOMINGUEZ",
        "authorized_official_first_name": "HUMBERTO",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "386-668-4411",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "FL",
            "license": "ME29577",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "038066100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Debary, FL
• Providers in Debary, FL by specialty
• Primary Care Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.