Healthcare Provider Details

I. General information

NPI: 1316862584
Provider Name (Legal Business Name): DOMENECH MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO. COTTO MABU CARR 189, R922 KO
HUMACAO PR
00791
US

IV. Provider business mailing address

219 AVE FONT MARTELO
HUMACAO PR
00791-3362
US

V. Phone/Fax

Practice location:
  • Phone: 787-363-6670
  • Fax:
Mailing address:
  • Phone: 787-363-6670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN DOMENECH
Title or Position: PRESIDENT
Credential: MD
Phone: 787-363-6670