Dominguez, Carmen Leticia

Dominguez, Carmen Leticia is an individual health care provider with primary practice located at 320 North Clyde Morris Blvd , Daytona Beach FL 32114-2733. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pain Medicine, which is considered as her primary health care specialty. Dominguez, Carmen Leticia can be contacted via phone (386) 238-3226.

Contact Information

Primary practice address
320 North Clyde Morris Blvd Daytona Beach FL 32114-2733
Phone: (386) 238-3226
Fax: (386) 238-3260
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pain Medicine 207LP2900X 25MA07822000 New Jersey

Profile Details

NPI number 1396775334
LBN Legal business name Dominguez, Carmen Leticia
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 4th, 2006
Last updated Apr 29th, 2016 - about 8 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 1396775334 NPPES
Florida Other 1396775334 TRICARE
Florida Other P01061992 TRICARE
Florida Other 01076 TRICARE
Florida MEDICAID 278835700 TRICARE

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