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General NPI Number Information
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NPI Number | 1831509702
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Entity Type | Individual
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Provider Name | LOUIS S. DOMINGUEZ P.A
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Gender | Male
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Dates
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Enumeration Date | 05/01/2014
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Last Update Date | 10/26/2016
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Provider Practice Location Address
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Address Line | 41 MALL RD LAHEY HOSPITAL AND MEDICAL CENTER
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City | BURLINGTON
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State | MA
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Zip | 01805-0001
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Country | US
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Telephone | 781-744-8100
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Fax | 781-744-5213
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Provider Business Mailing Address
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Address Line | 41 MALL RD LAHEY HOSPITAL AND MEDICAL CENTER
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City | BURLINGTON
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State | MA
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Zip | 01805-0001
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Country | US
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Telephone | 781-744-8100
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Fax | 781-744-5213
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 3093
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA4988
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License Number State | MA
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