Provider Demographics
NPI:1932934106
Name:DOMINGUEZ PRENDES, IRENE MERCEDES
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:MERCEDES
Last Name:DOMINGUEZ PRENDES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5430 SW 97TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7270
Mailing Address - Country:US
Mailing Address - Phone:305-496-7549
Mailing Address - Fax:
Practice Address - Street 1:5430 SW 97TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7270
Practice Address - Country:US
Practice Address - Phone:305-496-7549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-05
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9286501163WS0200X
FL11034477363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WS0200XNursing Service ProvidersRegistered NurseSchool