Healthcare Provider Details

I. General information

NPI: 1487682340
Provider Name (Legal Business Name): ANTONIO DOMINGUEZ ROMERO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 AVE MUNOZ RIVERA EDIF DARLINGTON OF: L1
SAN JUAN PR
00925
US

IV. Provider business mailing address

83 CERVANTES APT 3B CONDADO
SAN JUAN PR
00907
US

V. Phone/Fax

Practice location:
  • Phone: 787-600-7798
  • Fax: 787-545-1134
Mailing address:
  • Phone: 787-600-7798
  • Fax: 787-545-1134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number11771
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: