Provider Demographics
NPI:1275519332
Name:DOMINGUEZ VENTURA, ALBERTO (MD)
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:
Last Name:DOMINGUEZ VENTURA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 INDIAN SCHOOL RD NE
Mailing Address - Street 2:STE 110
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-3991
Mailing Address - Country:US
Mailing Address - Phone:505-727-7096
Mailing Address - Fax:
Practice Address - Street 1:201 CEDAR ST SE
Practice Address - Street 2:SUITE 306
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4917
Practice Address - Country:US
Practice Address - Phone:505-563-1000
Practice Address - Fax:505-563-1010
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36052208600000X
MN46968208G00000X
NMMD2011-0499208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN323605600Medicaid
I04411Medicare UPIN
MN323605600Medicaid