Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 260757 | NY |
NPI | 1013216704 |
---|---|
Provider Name | Maria Dominguez |
First Address | Rochester, NY 14621-3001 |
Second Address | Rochester, NY 14621-3001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2011 |
Last Update Date | 10/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03347537 | (05) | NY |