Healthcare Provider Details

I. General information

NPI: 1386370682
Provider Name (Legal Business Name): CATARINA DOMINGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 WEST AVE STE 1
SAN ANTONIO TX
78213-1837
US

IV. Provider business mailing address

101 FEU FOLLET RD STE 100
LAFAYETTE LA
70508-4234
US

V. Phone/Fax

Practice location:
  • Phone: 713-686-9194
  • Fax: 713-686-9413
Mailing address:
  • Phone: 713-686-9194
  • Fax: 713-686-9413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number67741
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: