Provider Demographics
NPI:1285985184
Name:ALCANTARA, DOMNINA (M D)
Entity type:Individual
Prefix:MRS
First Name:DOMNINA
Middle Name:
Last Name:ALCANTARA
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COND TUREY # 555
Mailing Address - Street 2:APTO. 501
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923-1549
Mailing Address - Country:US
Mailing Address - Phone:787-587-5520
Mailing Address - Fax:
Practice Address - Street 1:COND TUREY # 555
Practice Address - Street 2:APTO. 501
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-1549
Practice Address - Country:US
Practice Address - Phone:787-587-5520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR002712103T00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling