Provider Demographics
NPI:1629441910
Name:RICARDO DOMINGUEZ, LSA, INC.
Entity Type:Organization
Organization Name:RICARDO DOMINGUEZ, LSA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LSA
Authorized Official - Prefix:MR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:972-281-7992
Mailing Address - Street 1:2024 HIGHRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2024 HIGHRIDGE LN
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065
Practice Address - Country:US
Practice Address - Phone:972-281-7992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00529246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty