MEDICARE: MATTHEW DOMINGUEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZE0600X	Electroneurodiagnostic Specialist/Technologist

General Provider Information

NPI Number	:	1407305741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW DOMINGUEZ

Provider Business Mailing Address
First Line	:	6900 DALLAS PKWY
Second Line	:	SUITE 700
City	:	PLANO
State	:	TX
Zip	:	75024-7144
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6900 DALLAS PKWY
Second Line	:	SUITE 700
City	:	PLANO
State	:	TX
Zip	:	75024-7144
Country	:	US
Telephone Number	:	214-396-7725
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2016
Last Update Date	:	09/28/2016

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Directions to “ MATTHEW DOMINGUEZ ” Practice Location

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