Provider Demographics
NPI:1427043785
Name:DOMENECH, GABRIEL (MD)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:DOMENECH
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:GABRIEL
Other - Middle Name:
Other - Last Name:DOMENECH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1515 WINDJAMMER WAY
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-5035
Mailing Address - Country:US
Mailing Address - Phone:954-253-3114
Mailing Address - Fax:
Practice Address - Street 1:201 NW 82ND AVE STE 201
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1854
Practice Address - Country:US
Practice Address - Phone:954-314-7100
Practice Address - Fax:954-324-7133
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL78342207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP958304OtherOPTIMUM
FL9781OtherDIMENSION HEALTH
FLP01391282OtherRR MEDICARE
FL5379008OtherCIGNA
FL5733554OtherAETNA
FL46944OtherBCBS
FLF00215771101OtherUNITED
FLP1019778OtherFREEDOM
FL198641OtherWELLCARE
FL263268OtherAVMED
FLQMP000005289550OtherMOLINA
FL46944VMedicare PIN
FLP01391282OtherRR MEDICARE
FLQMP000005289550OtherMOLINA
FL5379008OtherCIGNA