Dominguez, Ivelisse

Dominguez, Ivelisse is an sole proprietor health care provider with primary practice located at 24 Calle Santiago Palmer Sur , Guayama PR 00784. She recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Dental Providers / General Practice. Dental Providers / General Practice is her primary health care specialty. Dominguez, Ivelisse can be contacted via phone (787) 678-7806.

Contact Information

Primary practice address
24 Calle Santiago Palmer Sur Guayama PR 00784
Fax:
Website:

Health care specialties

Profile Details

NPI number 1386098655
LBN Legal business name Dominguez, Ivelisse
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 22nd, 2016
Last updated Aug 6th, 2020 - about 6 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1386098655 NPPES
Florida MEDICAID 022622800

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