Provider Demographics
NPI:1134434608
Name:DOMINGUEZ, ROBERTO QUINTERO (RPH)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:QUINTERO
Last Name:DOMINGUEZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 W. BANDERA RD
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2523
Mailing Address - Country:US
Mailing Address - Phone:830-816-2093
Mailing Address - Fax:830-816-2038
Practice Address - Street 1:420 W BANDERA RD
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2523
Practice Address - Country:US
Practice Address - Phone:830-816-2093
Practice Address - Fax:830-816-2038
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33012183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist