Provider Demographics
NPI:1376985903
Name:DOMINGUEZ, DANIEL LEANDRO (LAC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:LEANDRO
Last Name:DOMINGUEZ
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 SENECA ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14204-2056
Mailing Address - Country:US
Mailing Address - Phone:716-578-4734
Mailing Address - Fax:
Practice Address - Street 1:346 SENECA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14204-2056
Practice Address - Country:US
Practice Address - Phone:716-578-4734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005123-01171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist