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NPI Code Detail

MEDICARE: LEAH MARIE GROVE DOMINGUEZ FNP

MEDICARE: LEAH MARIE GROVE DOMINGUEZ FNP
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
1363LF0000XFamily Nurse PractitionerAP144549TX

General Provider Information

NPI Number : 1750911483
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEAH MARIE GROVE DOMINGUEZ FNP
Provider Business Mailing Address
First Line : 517 SW MILITARY DR STE 106
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78221-1639
Country : US
Telephone Number : 210-921-0322
Fax Number : 210-921-1451
Provider Business Practice Location Address
First Line : 517 SW MILITARY DR STE 106
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78221-1639
Country : US
Telephone Number : 210-921-0322
Fax Number : 210-921-1451
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2020
Last Update Date : 12/19/2023

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Directions to “ LEAH MARIE GROVE DOMINGUEZ FNP” Practice Location

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