Provider Demographics
NPI:1639791072
Name:MATTHEWS, DOMINQIUE SHONTRELL (CNA/MHA)
Entity Type:Individual
Prefix:
First Name:DOMINQIUE
Middle Name:SHONTRELL
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:CNA/MHA
Other - Prefix:
Other - First Name:DOMINIQUE
Other - Middle Name:SHONTRELL
Other - Last Name:HAMBRIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12000 MARTIN LUTHER KING BLVD APT 2139
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77048-3625
Mailing Address - Country:US
Mailing Address - Phone:832-875-8710
Mailing Address - Fax:
Practice Address - Street 1:12000 MARTIN LUTHER KING BLVD APT 2139
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77048-3625
Practice Address - Country:US
Practice Address - Phone:832-875-8710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health