Provider Demographics
NPI:1578055695
Name:DOMINGUEZ, VASTI ESTHER
Entity Type:Individual
Prefix:
First Name:VASTI
Middle Name:ESTHER
Last Name:DOMINGUEZ
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 1:2120 EL PASEO ST APT 706
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-3229
Mailing Address - Country:US
Mailing Address - Phone:352-359-6157
Mailing Address - Fax:
Practice Address - Street 1:3333 BAYSHORE BLVD STE 340
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1960
Practice Address - Country:US
Practice Address - Phone:713-910-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114510235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114510OtherTEXAS DEPARTMENT OF LICENSING AND REGULATION