Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | ME0084811 | FL |
N | 2080P0204X | Pediatric Emergency Doctor | ME84811 | FL |
Y | 208D00000X | General Practice Physician | ME84811 | FL |
NPI | 1518975002 |
---|---|
Provider Name | Dr. Domingo J Leal |
First Address | Coral Gables, FL 33146 |
Second Address | Coral Gables, FL 33146 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 19/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
264092900 | (05) | FL |
BL7742857 | DEA NUMBER (01) | FL |
H79351 | (02) | FL |
ME0084811 | MEDICAL LICENSE NUMBER (01) | FL |