Provider Demographics
NPI:1386118396
Name:DOMINGUEZ, MARIA F (SURGICAL ASSISTANT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:F
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:SURGICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5007 FM 1960 RD W APT 434
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-4555
Mailing Address - Country:US
Mailing Address - Phone:346-757-8680
Mailing Address - Fax:
Practice Address - Street 1:5007 FM 1960 RD W APT 434
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-4555
Practice Address - Country:US
Practice Address - Phone:346-757-8680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18-560246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant