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General NPI Number Information
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NPI Number | 1205386455
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Entity Type | Organization
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Legal Business Name | DOMINION PROVIDER SERVICES, LLC
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Dates
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Enumeration Date | 10/12/2016
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Last Update Date | 10/12/2016
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Provider Practice Location Address
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Address Line | 1008 E HILLSIDE RD
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City | LAREDO
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State | TX
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Zip | 78041-3287
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Country | US
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Telephone | 956-568-3979
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Fax | 956-568-4014
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Provider Business Mailing Address
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Address Line | 1008 E HILLSIDE RD
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City | LAREDO
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State | TX
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Zip | 78041-3287
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Country | US
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Telephone | 956-568-3979
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Fax | 956-568-4014
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MRS. MARIA ELENA HINOJOSA
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Credential |
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Telephone | 956-568-3979
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 016977
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License Number State | TX
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