Provider Demographics
NPI:1033323266
Name:DOMINGUEZ MARTINEZ, HILKAMIDA DEL CARMEN (DC)
Entity Type:Individual
Prefix:DR
First Name:HILKAMIDA
Middle Name:DEL CARMEN
Last Name:DOMINGUEZ MARTINEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EXT ALTA VISTA CALLE 27 ZZ-2
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00731
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:787-284-3619
Practice Address - Street 1:NUMBER 2 ANA D PEREZ MARSHAND STREET
Practice Address - Street 2:INDUSTRIAL REPARADA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00732-7004
Practice Address - Country:US
Practice Address - Phone:787-840-0052
Practice Address - Fax:787-284-3619
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2543103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities