Individual
JACQUELINE DOMINGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
21610 HOLLIS AVE, QUEENS VILLAGE, NY 11429-1949
(718) 593-2596
Mailing address
21610 HOLLIS AVE, QUEENS VILLAGE, NY 11429-1949
(718) 593-2596
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
3562243
NY
Other
Enumeration date
08/09/2021
Last updated
08/09/2021
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