MEDICARE: KARIANA DOMINGUEZ 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	163WE0003X	Emergency Registered Nurse	917926	TX
2	363LF0000X	Family Nurse Practitioner	1030506	TX

General Provider Information

NPI Number	:	1750984621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARIANA DOMINGUEZ NP

Provider Business Mailing Address
First Line	:	1506 AIRLINE N
Second Line	:
City	:	ROSHARON
State	:	TX
Zip	:	77583-7722
Country	:	US
Telephone Number	:	281-753-6134
Fax Number	:

Provider Business Practice Location Address
First Line	:	2024 RICHMOND AVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-3424
Country	:	US
Telephone Number	:	832-930-7660
Fax Number	:

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

Provider Enumeration Date	:	11/20/2020
Last Update Date	:	06/04/2023

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