Provider Demographics
NPI:1497194674
Name:DOMINGUEZ, GLAYMAR
Entity Type:Individual
Prefix:
First Name:GLAYMAR
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29207 DEPT MEDICINA DE EMERGENCIA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929
Mailing Address - Country:US
Mailing Address - Phone:787-757-1800
Mailing Address - Fax:787-750-0930
Practice Address - Street 1:AVE. 65 DE INFANTERIA, CARR.3, KM 8.3
Practice Address - Street 2:HOSPITAL DE LA UPR, DR. FEDERICO TRILLA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-757-1800
Practice Address - Fax:787-750-0930
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2017-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19344207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine