Dominguez, Carmen Leticia
Dominguez, Carmen Leticia is an individual health care provider with primary practice located at 320 North Clyde Morris Blvd , Daytona Beach FL 32114-2733. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pain Medicine, which is considered as her primary health care specialty. Dominguez, Carmen Leticia can be contacted via phone (386) 238-3226.Contact Information
Primary practice address
320 North Clyde Morris Blvd
Daytona Beach FL 32114-2733
Phone: (386) 238-3226
Fax: (386) 238-3260
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pain Medicine | 207LP2900X | 25MA07822000 | New Jersey |
Profile Details
| NPI number | 1396775334 |
|---|---|
| LBN Legal business name | Dominguez, Carmen Leticia |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 4th, 2006 |
| Last updated | Apr 29th, 2016 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1396775334 | NPPES |
| Florida | Other | 1396775334 | TRICARE |
| Florida | Other | P01061992 | TRICARE |
| Florida | Other | 01076 | TRICARE |
| Florida | MEDICAID | 278835700 | TRICARE |
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