Individual
FERNANDO DOMINGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
1130 BEACHVIEW ST, DALLAS, TX 75218-3700
(469) 341-5676
Mailing address
9730 ASH CREEK DR, DALLAS, TX 75228-3602
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT6919
TX
Other
Enumeration date
11/22/2017
Last updated
03/17/2018
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