Healthcare Provider Details

I. General information

NPI: 1912817800
Provider Name (Legal Business Name): MARIA DOMINGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3869 YESTEREVE LN
LAS CRUCES NM
88012-8068
US

IV. Provider business mailing address

10591 LAS ALTURAS DR
MESQUITE NM
88048-0505
US

V. Phone/Fax

Practice location:
  • Phone: 575-635-6609
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: