Healthcare Provider Details

I. General information

NPI: 1730290453
Provider Name (Legal Business Name): DOMINGO LLAURADOR RT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CALLE CASIA
SAN JUAN PR
00921-3200
US

IV. Provider business mailing address

FM4 CALLE JOSE PH HERNANDEZ
TOA BAJA PR
00949-2817
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-7582
  • Fax:
Mailing address:
  • Phone: 787-641-7582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number311
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: