Provider Demographics
NPI:1689939050
Name:JONES, DOMINIC MANUEL
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:MANUEL
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9503 CHAPELSTONE CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77044-6500
Mailing Address - Country:US
Mailing Address - Phone:832-541-3035
Mailing Address - Fax:
Practice Address - Street 1:9503 CHAPELSTONE CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77044-6500
Practice Address - Country:US
Practice Address - Phone:832-541-3035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02530206172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver