MEDICARE: MINEYLIS DOMINGUEZ BRIZUELA NP

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	363LF0000X	Family Nurse Practitioner	358579	NY

General Provider Information

NPI Number	:	1508724196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINEYLIS DOMINGUEZ BRIZUELA NP

Provider Business Mailing Address
First Line	:	8815 REAMER ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-2517
Country	:	US
Telephone Number	:	832-846-1777
Fax Number	:

Provider Business Practice Location Address
First Line	:	8815 REAMER ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-2517
Country	:	US
Telephone Number	:	832-846-1777
Fax Number	:

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

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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