GABRIEL DOMENECH MD PA
Osteopathic Medicine at Hollywood Blvd, Hollywood, FL

License number
Florida ME 78342
Category
Osteopathic Medicine
Type
Hematology & Oncology
Owner
Name: GABRIEL DOMENECH M.D.
Title: OWNER
Phone: (954) 961-9200
Address
Address
3850 Hollywood Blvd SUITE 1-B, Hollywood, FL 33021
National Provider ID: 1417900994
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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GABRIEL DOMENECH, M.D., PA

Hollywood, FL

Status:
Inactive
Inactive reason:
Reinstatement
Registration:
Feb 16, 2006
Inactive since:
Oct 1, 2010
Addresses:
12741 Miramar Pkwy SUITE 306, Hollywood, FL 33027 (Physical)
1515 Windjammer Way, Hollywood, FL 33019
3850 Hollywood Blvd, Hollywood, FL 33021
State ID:
P06000023771
Business type:
Florida Profit Corporation
Director, President:
Gabriel Md Domenech (Director, President), 12741 Miramar Pkwy, Hollywood, FL 33027 (Physical)
Agent:
Bernard Singer,3107 Stirling Rd SUITE 104, Fort Lauderdale, FL 33312 (Physical)
EIN:
20-4327683

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