Luis Alberto Dominguez Carrazquillo, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1099 Issued in PR

Practice address

Calle Palmer Sur #24
Guayama, PR 00784-7610

Phone

(787) 866-3631

Fax

(787) 866-8690

NPI assigned

Jul 7, 2005

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Enrolled in PR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dominguez Family Dental, CSP

  • General Practice Dentistry
  • Guayama, PR
  • NPI 1023713740
  NPD (past)
• Jaruco Dental Services CSP

  • General Practice Dentistry
  • Guayama, PR
  • NPI 1568841484
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1659379303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 623",
            "city": "GUAYAMA",
            "state": "PR",
            "postal_code": "007850623",
            "telephone_number": "787-866-3631",
            "fax_number": "787-866-8690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CALLE PALMER SUR #24",
            "city": "GUAYAMA",
            "state": "PR",
            "postal_code": "007847610",
            "telephone_number": "787-866-3631",
            "fax_number": "787-866-8690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINGUEZ CARRAZQUILLO",
        "first_name": "LUIS",
        "middle_name": "ALBERTO",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PR",
            "license": "1099",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UIA",
            "identifier": "1099",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IMC",
            "identifier": "8634",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN HEALTH",
            "identifier": "26016",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "6540025",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MENONITA",
            "identifier": "1099",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CRUZ AZUL",
            "identifier": "40624",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRIPLE SSS",
            "identifier": "4-1072",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maria Diaz Rodriguez
• Magda Iris Diaz Velazquez, O.D.
• Gladymar Diaz
• Jorge Amaro Diaz, M.S.W.
• Yesmarie Diaz, MS
• Dominguez Family Dental, CSP
• Ivelisse Dominguez, DMD
• Dr Eduardo Nadal Ortiz Dba Arco Reflejo Grupo Medicina Fisica Y Rehab
• Dr. Carlos Acevedo Rego, C.S.P.
• Dr. Emilio Paez Chiropractic Center, PSC.

• General Practice Dentistry in Guayama, PR
• Providers in Guayama, PR by specialty
• General Practice Dentistry in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.