Provider Demographics
NPI:1508145251
Name:DOMINGUEZ MUSTAFA, ROLANDO (MD)
Entity type:Individual
Prefix:DR
First Name:ROLANDO
Middle Name:
Last Name:DOMINGUEZ MUSTAFA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 SW ROSEMARY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32024-6715
Mailing Address - Country:US
Mailing Address - Phone:973-610-6389
Mailing Address - Fax:386-719-9013
Practice Address - Street 1:777 W DUVAL ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-5806
Practice Address - Country:US
Practice Address - Phone:386-755-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME123013208M00000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist