Healthcare Provider Details

I. General information

NPI: 1952229486
Provider Name (Legal Business Name): GLENDA L DOMINICCI CAMACHO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 01 BOX 32888 BARRIO ANONES
LAS MARIAS PR
00670
US

IV. Provider business mailing address

HC 1 BOX 3288
LAS MARIAS PR
00670-9542
US

V. Phone/Fax

Practice location:
  • Phone: 787-460-6231
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number88457
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: