Provider Demographics
NPI:1952362345
Name:DOMINGUEZ, MARIA S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:S
Last Name:DOMINGUEZ
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:PO BOX 6727
Mailing Address - Street 2:CARRETERA #2 KM 39 MB COLLEGO
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-5727
Mailing Address - Country:US
Mailing Address - Phone:787-807-8302
Mailing Address - Fax:787-807-7218
Practice Address - Street 1:CARRETERA #2 KM 39 MB COLLEGO
Practice Address - Street 2:
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00960-5727
Practice Address - Country:US
Practice Address - Phone:787-807-8302
Practice Address - Fax:787-807-7218
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14458208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR84678Medicaid
PR84678Medicare ID - Type Unspecified
PR84678Medicaid