Individual
MR. JULIO MATA DOMINGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCDC
Contact information
Practice address
6800 PARK TEN BLVD STE 200S, SAN ANTONIO, TX 78213-4293
(210) 261-1042
Mailing address
6800 PARK TEN BLVD STE 200S, SAN ANTONIO, TX 78213-4293
(210) 261-1042
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
05/08/2019
Last updated
04/12/2022
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