Provider Demographics
NPI:1992096168
Name:DOMINGUEZ, KATHLYNN MICHELLE (MD, MPH)
Entity type:Individual
Prefix:
First Name:KATHLYNN
Middle Name:MICHELLE
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:K
Other - Middle Name:MICHELLE
Other - Last Name:DOMINGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:777 BANNOCK STREET
Mailing Address - Street 2:4TH FLOOR, DEPT OF EMERGENCY MEDICINE
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4507
Mailing Address - Country:US
Mailing Address - Phone:303-436-7142
Mailing Address - Fax:
Practice Address - Street 1:777 BANNOCK STREET
Practice Address - Street 2:4TH FLOOR, DEPT OF EMERGENCY MEDICINE
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4507
Practice Address - Country:US
Practice Address - Phone:303-436-7142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-22
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL-4121207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine