Most Relevant Information
Provider Data
| NPI Number: | 1003668096 |
| Provider Name: | MARIEMMA LISSETTE DOMENECH MD |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/03/2024 |
| Last Updated: | 04/03/2024 |
Provider Practice Location
2213 PONCE BYP
PONCE
PR
007171310
Practice Location Phone/Fax
| Phone: | 7878408686 |
| Fax: |
Provider Mailing Location
PO BOX 250268
AGUADILLA
PR
006040268
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |