MEDICARE: ALBERTO DOMINGUEZ VENTURA MD

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
1	208600000X	Surgery Physician	36052	AZ
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	46968	MN
3	208600000X	Surgery Physician	MD2011-0499	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275519332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALBERTO DOMINGUEZ VENTURA MD

Provider Business Mailing Address
First Line	:	4101 INDIAN SCHOOL RD NE
Second Line	:	STE 110
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-3991
Country	:	US
Telephone Number	:	505-727-7096
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 CEDAR ST SE
Second Line	:	SUITE 306
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4917
Country	:	US
Telephone Number	:	505-563-1000
Fax Number	:	505-563-1010

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	02/04/2020

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Directions to “ ALBERTO DOMINGUEZ VENTURA MD” Practice Location

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