Active NPI
Lisandra M Dominguez I, PSY.D.
- Clinical Psychologist
- Humacao, PR
National Provider Identifier
1669199089
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 7791
- Practice address
- 1 Calle Ramon Gomez S
Humacao, PR 00791-3939 - Phone
- (787) 547-4433
- NPI assigned
- Oct 26, 2022
- Last updated
- Jan 2, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 7791 | PR | Primary |
Addresses
Primary practice location
1 Calle Ramon Gomez S
Humacao, PR 00791-3939
Mailing address
PO Box 9023711
San Juan, PR 00902-3711
Phone (787) 993-3885
Other practice location 1
Ave Sakura Villa Blanca Industrial Park
235-A
Caguas, PR 00725
Phone (787) 705-5565
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7791 | PR | MD | Speech-Language Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1666742400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704153600000",
"number": "1669199089",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 9023711",
"city": "SAN JUAN",
"state": "PR",
"postal_code": "009023711",
"telephone_number": "787-993-3885"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 CALLE RAMON GOMEZ S",
"city": "HUMACAO",
"state": "PR",
"postal_code": "007913939",
"telephone_number": "787-547-4433"
}
],
"practiceLocations": [
{
"address_1": "Ave Sakura Villa Blanca Industrial Park",
"address_2": "235-A",
"address_purpose": "LOCATION",
"city": "Caguas",
"state": "PR",
"postal_code": "00725",
"country_code": "US",
"telephone_number": "787-705-5565",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DOMINGUEZ",
"first_name": "LISANDRA",
"middle_name": "M",
"name_prefix": "Miss",
"name_suffix": "I",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-10-26",
"last_updated": "2024-01-02",
"certification_date": "2023-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PR",
"license": "7791",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Humacao, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.