Provider Demographics
NPI:1134600646
Name:DOMINGUEZ, DOMINGO AGUIRRE
Entity type:Individual
Prefix:
First Name:DOMINGO
Middle Name:AGUIRRE
Last Name:DOMINGUEZ
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 1:1008 W ROCKPORT ST
Mailing Address - Street 2:
Mailing Address - City:MATHIS
Mailing Address - State:TX
Mailing Address - Zip Code:78368-2161
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:696 FM 99
Practice Address - Street 2:
Practice Address - City:KARNES CITY
Practice Address - State:TX
Practice Address - Zip Code:78118-5009
Practice Address - Country:US
Practice Address - Phone:830-780-3944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210192224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant