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General NPI Number Information
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NPI Number | 1285377507
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Entity Type | Organization
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Legal Business Name | MDOC HEALTH SERVICES,LLC
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Dates
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Enumeration Date | 04/14/2022
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Last Update Date | 04/15/2022
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Provider Practice Location Address
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Address Line | 4371 S 1ST ST
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City | ABILENE
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State | TX
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Zip | 79605-1469
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Country | US
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Telephone | 325-701-4082
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Fax | 325-701-4081
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Provider Business Mailing Address
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Address Line | PO BOX 2799
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City | PORTER
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State | TX
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Zip | 77365-2799
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Country | US
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Telephone | 281-381-6190
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Fax | 281-747-7162
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Authorized Official
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Title or Position | MEMBER
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Name | ALIESKI MASTRAPA DOMINGUEZ
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Credential |
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Telephone | 281-381-6190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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