Jacob Mauro Dominguez, LPN
Licensed Practical Nurse in Bronx, NY. Individual provider (NPI-1).
NPI number1982122628
StatusActive
Last updated in NPPESJul 21, 2022
Details
- NPI
- 1982122628
- Entity type
- Individual (NPI-1)
- Name
- Jacob Mauro Dominguez
- Credential
- LPN
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Sep 1, 2017
- Last updated
- Jul 21, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 164W00000X | Licensed Practical Nurse | 329762 | NY | Yes |
Practice location
223 Brook AvBronx, NY 10454
Phone 718-541-5218
Mailing address
223 Brook AveBronx, NY 10454-4106
Phone 718-541-5218
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