Provider Demographics
NPI:1114448933
Name:SIFUENTES, DOMINGO CESAR III (LAT)
Entity Type:Individual
Prefix:MR
First Name:DOMINGO
Middle Name:CESAR
Last Name:SIFUENTES
Suffix:III
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12221 LESLIE RD
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023
Mailing Address - Country:US
Mailing Address - Phone:210-397-4846
Mailing Address - Fax:
Practice Address - Street 1:12221 LESLIE RD
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023
Practice Address - Country:US
Practice Address - Phone:210-884-5330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-01
Last Update Date:2017-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT41612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer