Provider Demographics
NPI:1730500422
Name:DOMINGUEZ, EMILIO JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILIO
Middle Name:JOSE
Last Name:DOMINGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 GREENS SHADE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-7812
Mailing Address - Country:US
Mailing Address - Phone:210-872-3375
Mailing Address - Fax:
Practice Address - Street 1:23 GREENS SHADE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-7812
Practice Address - Country:US
Practice Address - Phone:210-872-3375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1888102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst