| Carlos L Dominguez Md Pa | |
|
1857 Providence Blvd Deltona FL 32725-3811 | |
| (386) 789-8544 | |
| (386) 951-4809 |
| Full Name | Carlos L Dominguez Md Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 1857 Providence Blvd, Deltona, Florida |
| Authorized Official Name and Position | Carlos L Dominguez (OWNER/PRESIDENT) |
| Authorized Official Contact | 3867898544 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carlos L Dominguez Md Pa 1857 Providence Blvd Deltona FL 32725-3811 Ph: (386) 789-8544 | Carlos L Dominguez Md Pa 1857 Providence Blvd Deltona FL 32725-3811 Ph: (386) 789-8544 |
| NPI Number | 1730452970 |
|---|---|
| Provider Enumeration Date | 02/20/2012 |
| Last Update Date | 02/20/2012 |
| Medicare PECOS PAC ID | 4486814555 |
|---|---|
| Medicare Enrollment ID | O20120327000767 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730452970 | NPI | - | NPPES |
| 252750200 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME0072352 (Florida) | Primary |
| Provider Name | Carlos L Dominguez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104864768 PECOS PAC ID: 5698861789 Enrollment ID: I20071031000035 |
| Provider Name | Vanessa Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699296467 PECOS PAC ID: 9739586967 Enrollment ID: I20210930000722 |
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Multicare Physicians Psc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 634 Deltona Blvd, Deltona, FL 32725 Phone: 386-574-5565 Fax: 386-574-8567 |