Provider Demographics
NPI:1487682340
Name:DOMINGUEZ ROMERO, ANTONIO (MD)
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:
Last Name:DOMINGUEZ ROMERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 CERVANTES APT 3B
Mailing Address - Street 2:CONDADO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907
Mailing Address - Country:US
Mailing Address - Phone:787-600-7798
Mailing Address - Fax:787-545-1134
Practice Address - Street 1:1007 AVE MUNOZ RIVERA
Practice Address - Street 2:EDIF DARLINGTON OF: L1
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925
Practice Address - Country:US
Practice Address - Phone:787-600-7798
Practice Address - Fax:787-545-1134
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11771207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HX422AMedicare PIN