Healthcare Provider Details

I. General information

NPI: 1962658823
Provider Name (Legal Business Name): MARGARET M DOMBROWSKI DTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5693 S JONES BLVD STE 118
LAS VEGAS NV
89118-1967
US

IV. Provider business mailing address

4228 MASSERIA CT
NORTH LAS VEGAS NV
89031-3663
US

V. Phone/Fax

Practice location:
  • Phone: 702-889-9240
  • Fax:
Mailing address:
  • Phone: 702-982-6233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code136A00000X
TaxonomyRegistered Dietetic Technician
License Number835191
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: