Provider Demographics
NPI:1962658823
Name:DOMBROWSKI, MARGARET M (DTR)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:M
Last Name:DOMBROWSKI
Suffix:
Gender:F
Credentials:DTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4228 MASSERIA CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-3663
Mailing Address - Country:US
Mailing Address - Phone:702-982-6233
Mailing Address - Fax:
Practice Address - Street 1:5693 S JONES BLVD STE 118
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1967
Practice Address - Country:US
Practice Address - Phone:702-889-9240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY835191136A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY835191OtherDIETETIC ASSOCIATION