Provider Demographics
NPI:1588430318
Name:ALVAREZ DOMINGUEZ, ABEL RENE (SA-C)
Entity type:Individual
Prefix:
First Name:ABEL
Middle Name:RENE
Last Name:ALVAREZ DOMINGUEZ
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 INTREPID DR
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-5102
Mailing Address - Country:US
Mailing Address - Phone:786-526-7428
Mailing Address - Fax:
Practice Address - Street 1:2424 INTREPID DR
Practice Address - Street 2:
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610-5102
Practice Address - Country:US
Practice Address - Phone:786-526-7428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23-691246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant