Healthcare Provider Details

I. General information

NPI: 1770308124
Provider Name (Legal Business Name): DOMINGUEZ MEDICAL SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 AVE LOS ATLETICOS DE SAN GERMAN EDIFICIO RALI SUITE 215
SAN GERMAN PR
00683
US

IV. Provider business mailing address

URB. MONTE VERDE C 14 CALLE FLAMBOYAN
YAUCO PR
00698
US

V. Phone/Fax

Practice location:
  • Phone: 787-974-1384
  • Fax: 787-651-3343
Mailing address:
  • Phone: 787-974-1384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MR. ELVIS DOMINGUEZ
Title or Position: PRESIDENT
Credential:
Phone: 939-238-0593