Individual
JONATHAN DOMENECH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
BO COTTO MABU, CARR 189 R 922 K0, HUMACAO, PR 00791
(787) 228-0175
Mailing address
HC 1 BOX 6216, LAS PIEDRAS, PR 00771-9718
(787) 228-0175
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
24138
PR
Other
Enumeration date
09/30/2024
Last updated
09/30/2024
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