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NPI Code Detail

MEDICARE: PAOLA GALILEA RAMON DOMINGUEZ IDMT

MEDICARE: PAOLA GALILEA RAMON DOMINGUEZ IDMT
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
11710I1003XIndependent Duty Medical Technicians

General Provider Information

NPI Number : 1457110736
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAOLA GALILEA RAMON DOMINGUEZ IDMT
Provider Business Mailing Address
First Line : 1515 TRUEMPER ST
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78236-5583
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1515 TRUEMPER ST
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78236-5583
Country : US
Telephone Number : 210-910-1917
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2024
Last Update Date : 03/18/2024

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