Provider Demographics
NPI:1063627305
Name:DOMINGUEZ, NEIZA MILAGROS (16056)
Entity type:Individual
Prefix:
First Name:NEIZA
Middle Name:MILAGROS
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:16056
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8188
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-8188
Mailing Address - Country:US
Mailing Address - Phone:787-843-3439
Mailing Address - Fax:
Practice Address - Street 1:ROAD 506 HOSPITAL SAN CRISTOBAL
Practice Address - Street 2:
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780
Practice Address - Country:US
Practice Address - Phone:787-848-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16056208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice