Provider Demographics
NPI:1417562539
Name:DOMINGO, LOLITA MAGTOTO
Entity Type:Individual
Prefix:
First Name:LOLITA
Middle Name:MAGTOTO
Last Name:DOMINGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4522 BEXLEY TRL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-2082
Mailing Address - Country:US
Mailing Address - Phone:210-807-0602
Mailing Address - Fax:
Practice Address - Street 1:4522 BEXLEY TRL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259-2082
Practice Address - Country:US
Practice Address - Phone:210-807-0602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX751930163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse