Provider Demographics
NPI:1710493739
Name:DOMINGUEZ, YASMANY (DO)
Entity type:Individual
Prefix:DR
First Name:YASMANY
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13901 US HIGHWAY 1 STE 5
Mailing Address - Street 2:
Mailing Address - City:JUNO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-1612
Mailing Address - Country:US
Mailing Address - Phone:561-491-4666
Mailing Address - Fax:561-630-0312
Practice Address - Street 1:13901 US HIGHWAY 1 STE 5
Practice Address - Street 2:
Practice Address - City:JUNO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-1612
Practice Address - Country:US
Practice Address - Phone:561-491-4666
Practice Address - Fax:561-630-0312
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-28
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO5588207Q00000X, 207QA0505X, 390200000X
FLOS15998207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty