Provider Demographics
NPI:1871269431
Name:GOMEZ DOMINICCI, ANNETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:
Last Name:GOMEZ DOMINICCI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1843 BLVD LUIS A FERRE
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-1816
Mailing Address - Country:US
Mailing Address - Phone:787-901-3982
Mailing Address - Fax:787-866-3322
Practice Address - Street 1:80 CALLE 3 S
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-5520
Practice Address - Country:US
Practice Address - Phone:787-866-1212
Practice Address - Fax:787-866-3322
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22520208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice