Healthcare Provider Details

I. General information

NPI: 1285782789
Provider Name (Legal Business Name): DOMINGUEZ J-MAR LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 LOOP 193
WOLFFORTH TX
79382
US

IV. Provider business mailing address

PO BOX 1384 207 E LOOP 193
WOLFFORTH TX
79382-1384
US

V. Phone/Fax

Practice location:
  • Phone: 806-886-4010
  • Fax: 806-866-4061
Mailing address:
  • Phone: 806-866-4010
  • Fax: 806-866-4061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number0073642
License Number StateTX

VIII. Authorized Official

Name: MR. SAUL ESTRADA DOMINGUEZ
Title or Position: OWNER
Credential:
Phone: 806-866-4010