Individual
TABATHA DOMINGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
3200 AVENUE E, HONDO, TX 78861-3525
(830) 426-7444
Mailing address
PO BOX 752, HONDO, TX 78861-0752
(830) 931-5008
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP139722
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AP139722
—
TX
Enumeration date
11/15/2018
Last updated
07/12/2024
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