Healthcare Provider Details

I. General information

NPI: 1497927040
Provider Name (Legal Business Name): DONNELLYN ALEXANDER DOMINGUEZ L.M., CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2008
Last Update Date: 06/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 E FM 1830
ARGYLE TX
76226-4317
US

IV. Provider business mailing address

305 E FM 1830
ARGYLE TX
76226-4317
US

V. Phone/Fax

Practice location:
  • Phone: 972-653-2229
  • Fax: 866-941-5104
Mailing address:
  • Phone: 972-653-2229
  • Fax: 866-941-5104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number99051
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: