Provider Demographics
NPI:1972100600
Name:DOMINGUEZ, GRETEL DULCE
Entity type:Individual
Prefix:
First Name:GRETEL
Middle Name:DULCE
Last Name:DOMINGUEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 NW 42ND AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-4172
Mailing Address - Country:US
Mailing Address - Phone:305-204-0333
Mailing Address - Fax:
Practice Address - Street 1:860 NW 42ND AVE STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-4174
Practice Address - Country:US
Practice Address - Phone:305-946-1526
Practice Address - Fax:877-550-1853
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9466386163W00000X
FLAPRN11024150363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse