Healthcare Provider Details

I. General information

NPI: 1932998580
Provider Name (Legal Business Name): DOMINIC LUIS PAULA RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 EASTERN AVE # 5
BALTIMORE MD
21224-2735
US

IV. Provider business mailing address

1830 E MONUMENT ST FL 5
BALTIMORE MD
21287-0020
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-4176
  • Fax:
Mailing address:
  • Phone: 410-955-4176
  • Fax: 410-614-1652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberR237956
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: