Provider Demographics
NPI:1013522457
Name:DOMINGUEZ, LAURA (NCPT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:NCPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 LILLIAN LN
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-2518
Mailing Address - Country:US
Mailing Address - Phone:773-817-0477
Mailing Address - Fax:
Practice Address - Street 1:400 LILLIAN LN
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-2518
Practice Address - Country:US
Practice Address - Phone:224-242-9630
Practice Address - Fax:215-215-8838
Is Sole Proprietor?:No
Enumeration Date:2020-09-12
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL851198246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory