Individual
CARMEN LETICIA DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
320 NORTH CLYDE MORRIS BLVD, DAYTONA BEACH, FL 32114-2733
(386) 238-3226
(386) 238-3260
Mailing address
P.O. BOX 9671, DAYTONA BEACH, FL 32120-9671
(386) 676-7130
(386) 676-7125
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
25MA07822000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01076
BCBS
FL
01
—
1396775334
TRICARE
FL
05
—
278835700
—
FL
01
—
P01061992
RAILROAD
FL
Enumeration date
07/04/2006
Last updated
04/29/2016
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