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NPI Code Detail

MEDICARE: ESTELA M DOMINGUEZ AAS

MEDICARE:   ESTELA M DOMINGUEZ  AAS
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
1101YA0400XAddiction (Substance Use Disorder) Counselor13569TX

General Provider Information

NPI Number : 1538648043
Entity Type Code : Individual
Provider Name (Legal Business Name) : ESTELA M DOMINGUEZ AAS
Provider Business Mailing Address
First Line : 3840 HULEN ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-7277
Country : US
Telephone Number : 817-569-4300
Fax Number :
Provider Business Practice Location Address
First Line : 1527 HEMPHILL ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-4706
Country : US
Telephone Number : 817-335-3022
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2018
Last Update Date : 08/07/2018

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Directions to “ ESTELA M DOMINGUEZ AAS” Practice Location

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