Healthcare Provider Details

I. General information

NPI: 1073203865
Provider Name (Legal Business Name): ALVIO JAVIER DOMINGUEZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 UNIVERSITY BLVD
GALVESTON TX
77555-5302
US

IV. Provider business mailing address

PO BOX 650859
DALLAS TX
75265-0859
US

V. Phone/Fax

Practice location:
  • Phone: 409-266-7856
  • Fax:
Mailing address:
  • Phone: 409-772-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberBP10084371
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberP10084371
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: