Provider Demographics
NPI:1932930518
Name:DOMANGUE, ZANE JOSEPH (BA)
Entity type:Individual
Prefix:
First Name:ZANE
Middle Name:JOSEPH
Last Name:DOMANGUE
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4013 COUNTRY DR
Mailing Address - Street 2:
Mailing Address - City:BOURG
Mailing Address - State:LA
Mailing Address - Zip Code:70343-3606
Mailing Address - Country:US
Mailing Address - Phone:985-991-2526
Mailing Address - Fax:
Practice Address - Street 1:235 CIVIC CENTER BLVD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-5937
Practice Address - Country:US
Practice Address - Phone:985-226-1028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator