Provider Demographics
NPI:1134480163
Name:DOMINGUEZ, PABLO ANTONIO (MSED, MBA,BA)
Entity Type:Individual
Prefix:MR
First Name:PABLO
Middle Name:ANTONIO
Last Name:DOMINGUEZ
Suffix:
Gender:M
Credentials:MSED, MBA,BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 ISHAM ST
Mailing Address - Street 2:APT 2F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-2104
Mailing Address - Country:US
Mailing Address - Phone:212-567-4989
Mailing Address - Fax:
Practice Address - Street 1:521 ISHAM ST
Practice Address - Street 2:APT 2F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-2104
Practice Address - Country:US
Practice Address - Phone:212-567-4989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist