MEDICARE: DIANNE DOMINGUEZ RDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	1551	PR

General Provider Information

NPI Number	:	1407217672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANNE DOMINGUEZ RDN

Provider Business Mailing Address
First Line	:	I4 AVE SAN PATRICIO
Second Line	:	COND. SAN PATRICIO APTS 1706
City	:	GUAYNABO
State	:	PR
Zip	:	00968-3200
Country	:	US
Telephone Number	:	787-359-3731
Fax Number	:

Provider Business Practice Location Address
First Line	:	I4 AVE SAN PATRICIO
Second Line	:	COND. SAN PATRICIO APTS 1706
City	:	GUAYNABO
State	:	PR
Zip	:	00968-3200
Country	:	US
Telephone Number	:	787-359-3731
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2016
Last Update Date	:	03/15/2016

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