Provider Demographics
NPI:1124762620
Name:ANAYA, DOMINIC ANTHONY
Entity type:Individual
Prefix:
First Name:DOMINIC
Middle Name:ANTHONY
Last Name:ANAYA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3513 MEADOWSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-3546
Mailing Address - Country:US
Mailing Address - Phone:915-479-3518
Mailing Address - Fax:
Practice Address - Street 1:2101 W NORTHGATE DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-2650
Practice Address - Country:US
Practice Address - Phone:972-255-4460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty