Provider Demographics
NPI:1497927040
Name:DOMINGUEZ, DONNELLYN ALEXANDER (LM, CPM)
Entity Type:Individual
Prefix:
First Name:DONNELLYN
Middle Name:ALEXANDER
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 E FM 1830
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-4317
Mailing Address - Country:US
Mailing Address - Phone:972-653-2229
Mailing Address - Fax:866-941-5104
Practice Address - Street 1:305 E FM 1830
Practice Address - Street 2:
Practice Address - City:ARGYLE
Practice Address - State:TX
Practice Address - Zip Code:76226-4317
Practice Address - Country:US
Practice Address - Phone:972-653-2229
Practice Address - Fax:866-941-5104
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99051176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife