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General NPI Number Information
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NPI Number | 1710172093
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Entity Type | Organization
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Legal Business Name | DOMICILLIARY SERVICE LLC
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Dates
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Enumeration Date | 09/11/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1513 VICEROY DR
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City | DALLAS
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State | TX
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Zip | 75235-2303
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Country | US
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Telephone | 469-685-7020
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Fax | 214-920-8446
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Provider Business Mailing Address
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Address Line | 1513 VICEROY DR
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City | DALLAS
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State | TX
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Zip | 75235-2303
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Country | US
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Telephone | 469-685-7020
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Fax | 214-920-8446
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MANUEL S RIVERO
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Credential | M.D.
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Telephone | 469-595-9475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number |
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License Number State | TX
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