Provider Demographics
NPI:1740479195
Name:SPAIN, DOMINIQUE ELIZABETH
Entity type:Individual
Prefix:MS
First Name:DOMINIQUE
Middle Name:ELIZABETH
Last Name:SPAIN
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 1:515 CLARKSON ST
Mailing Address - Street 2:APT. #504
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-3224
Mailing Address - Country:US
Mailing Address - Phone:303-953-1493
Mailing Address - Fax:
Practice Address - Street 1:515 CLARKSON ST
Practice Address - Street 2:APT. #504
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3224
Practice Address - Country:US
Practice Address - Phone:303-953-1493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist