Individual
ELIZETTE DOMINGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
610 N SILVER ST, SILVER CITY, NM 88061-6779
(575) 956-6131
(575) 956-6947
Mailing address
410 E 11TH ST, SILVER CITY, NM 88061-6416
(575) 313-0528
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
NM
Other
Enumeration date
06/13/2023
Last updated
06/13/2023
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