Provider Demographics
NPI:1043517980
Name:DOMINGUEZ, DELIA A (A-SLP)
Entity Type:Individual
Prefix:
First Name:DELIA
Middle Name:A
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:A-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 MONTANA AVE
Mailing Address - Street 2:SUITE G & H
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-2155
Mailing Address - Country:US
Mailing Address - Phone:915-838-7604
Mailing Address - Fax:915-772-4633
Practice Address - Street 1:6601 MONTANA AVE
Practice Address - Street 2:SUITE G & H
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-2155
Practice Address - Country:US
Practice Address - Phone:915-838-7604
Practice Address - Fax:915-772-4633
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-11
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX359832355S0801X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149984001Medicaid
TX207164901Medicaid
TX149984001Medicaid
TX676535Medicare PIN