Healthcare Provider Details

I. General information

NPI: 1871646885
Provider Name (Legal Business Name): MS. LILIA LORENA COLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HUGO DOMINGUEZ DDS.PHD.

II. Dates (important events)

Enumeration Date: 01/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FCO. VILLA 229 INT 6
CD. JUAREZ CHIHUAHUA
32000
MX

IV. Provider business mailing address

PO BOX 3871
EL PASO TX
79923-3871
US

V. Phone/Fax

Practice location:
  • Phone: 656-632-3550
  • Fax:
Mailing address:
  • Phone: 915-373-1852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1009581
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: