# DR. IVAN DOMINGUEZ

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1104070705
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | 021391 | PR | Yes |
| 2086S0129X | Vascular Surgery Physician | 265300 | NY | — |

## Other

- **Enumeration date:** 11/10/2008
- **Last updated:** 12/20/2019