Provider Demographics
NPI:1396333068
Name:DOMINGUEZ RIVERA, GRECIA (MD)
Entity type:Individual
Prefix:
First Name:GRECIA
Middle Name:
Last Name:DOMINGUEZ RIVERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 531968
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78553-1968
Mailing Address - Country:US
Mailing Address - Phone:338-874-8638
Mailing Address - Fax:562-966-8579
Practice Address - Street 1:2102 TREASURE HILLS BLVD
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8736
Practice Address - Country:US
Practice Address - Phone:956-296-1491
Practice Address - Fax:956-389-4603
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10073601390200000X
TXU8048207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program