MEDICARE: DR. JUAN DOMINGUEZ JR. AU.D

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	231H00000X	Audiologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14414244	OTHER		ASHA NUMBER

General Provider Information

NPI Number	:	1437720646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN DOMINGUEZ JR. AU.D

Provider Business Mailing Address
First Line	:	3220 W FLOWERING CACTUS CT
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-5035
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3220 W FLOWERING CACTUS CT
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-5035
Country	:	US
Telephone Number	:	928-388-5433
Fax Number	:

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

Provider Enumeration Date	:	07/08/2021
Last Update Date	:	07/08/2021

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