Provider Demographics
NPI:1104237643
Name:CLEVELAND, DOMINIQUE D (MD)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:D
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DOMINIQUE
Other - Middle Name:D
Other - Last Name:WASHINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:23920 KATY FWY STE 440
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-0881
Mailing Address - Country:US
Mailing Address - Phone:281-392-2266
Mailing Address - Fax:
Practice Address - Street 1:23920 KATY FWY STE 440
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494
Practice Address - Country:US
Practice Address - Phone:281-392-2266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10050319207V00000X
TXR6309207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology