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
Phone: (787) 678-7806
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Student, Health Care / Student in an Organized Health Care Education/Training Program | 390200000X | ||
| Dental Providers / General Practice | 1223G0001X | 4440604 | Puerto Rico |
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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1386098655 | NPPES |
| Florida | MEDICAID | 022622800 |
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