Individual
CARMEN DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1058 BURT DR, NACOGDOCHES, TX 75965-7228
(936) 645-9240
Mailing address
1058 BURT DR, NACOGDOCHES, TX 75965-7228
(936) 645-9240
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
342439
TX
Other
Enumeration date
04/11/2019
Last updated
04/11/2019
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