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NPI Code Detail

MEDICARE: SAN JUANITA DOMINGUEZ M.S., SLP INTERN

MEDICARE: SAN JUANITA DOMINGUEZ M.S., SLP INTERN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist115540TX

General Provider Information

NPI Number : 1033777255
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAN JUANITA DOMINGUEZ M.S., SLP INTERN
Provider Business Mailing Address
First Line : 1455 LOUISIANA AVE APT 6106
Second Line :
City : LEAGUE CITY
State : TX
Zip : 77573-5825
Country : US
Telephone Number : 956-206-1750
Fax Number :
Provider Business Practice Location Address
First Line : 3333 BAYSHORE BLVD STE 340
Second Line :
City : PASADENA
State : TX
Zip : 77504-1960
Country : US
Telephone Number : 713-910-5437
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2019
Last Update Date : 06/03/2019

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Directions to “ SAN JUANITA DOMINGUEZ M.S., SLP INTERN” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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