Individual
MR. EDWIN GILBERTO DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SFIDC
Contact information
Practice address
43 SMITH RD, NEWPORT, RI 02841-1006
(401) 841-6128
Mailing address
22 ENTERPRISE CT, NEWPORT, RI 02840-1013
(732) 600-6575
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
09/09/2013
Last updated
09/09/2013
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