Provider Demographics
NPI:1871838508
Name:ESPAILLAT, DOMINIQUE FRANCHESKA
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:FRANCHESKA
Last Name:ESPAILLAT
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:URB.BRISAS DE ANASCO CALLER 10
Mailing Address - Street 2:CASA GG 8
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610
Mailing Address - Country:US
Mailing Address - Phone:787-996-6770
Mailing Address - Fax:
Practice Address - Street 1:METRO OFFICE PARK # 6
Practice Address - Street 2:CALLE 1 SUITE 101
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-1704
Practice Address - Country:US
Practice Address - Phone:787-522-5252
Practice Address - Fax:787-522-5253
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5588183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5588OtherPHARMACIST TECHNICHIAN