MEDICARE: DR. ANNETTE GOMEZ DOMINICCI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	22520	PR

General Provider Information

NPI Number	:	1871269431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNETTE GOMEZ DOMINICCI MD

Provider Business Mailing Address
First Line	:	1867 BLVD LUIS A FERRE
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00728-1816
Country	:	US
Telephone Number	:	787-901-3982
Fax Number	:	787-866-3322

Provider Business Practice Location Address
First Line	:	1867 BLVD LUIS A FERRE
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00728-1816
Country	:	US
Telephone Number	:	939-384-0738
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2021
Last Update Date	:	04/16/2025

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