| NPI | 1316902505 |
|---|---|
| Former Name | LOREN ANN DOMINGUEZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS12462) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 1933) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2018-09-13 |