Individual
MR. NEVAN DOMINGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1 ROYAL WAY, KANSAS CITY, MO 64129-1695
(505) 250-1464
Mailing address
2214 VIA ESTERLINA AVE SE, RIO RANCHO, NM 87124-8714
(505) 250-1464
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/06/2016
Last updated
03/26/2017
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