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General NPI Number Information
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NPI Number | 1629441910
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Entity Type | Organization
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Legal Business Name | RICARDO DOMINGUEZ, LSA, INC.
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Dates
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Enumeration Date | 11/09/2015
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Last Update Date | 11/09/2015
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Provider Practice Location Address
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Address Line | 2024 HIGHRIDGE LN
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City | MIDLOTHIAN
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State | TX
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Zip | 76065
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Country | US
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Telephone | 972-281-7992
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Fax |
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Provider Business Mailing Address
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Address Line | 2024 HIGHRIDGE LN
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City | MIDLOTHIAN
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State | TX
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Zip | 76065
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LSA
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Name | MR. RICARDO DOMINGUEZ JR.
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Credential |
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Telephone | 972-281-7992
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | SA00529
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License Number State | TX
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