Individual
MR. LEROY ANTHONY DOMINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
200 BLOSSOM ST, WEBSTER, TX 77598-4204
(832) 632-6372
Mailing address
PO BOX 650859, DEPT 710, DALLAS, TX 75265-7773
(409) 747-6240
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
663623
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
AP114089
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
177072901
—
TX
Enumeration date
09/22/2006
Last updated
08/01/2022
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