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Individual

FERMIN ELIZALDE DOMINGUEZ III

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
3463 MAGIC DR STE T21, SAN ANTONIO, TX 78229-3621
(210) 614-8101
Mailing address
9219 CENTRO GRANDE, SAN ANTONIO, TX 78245-1291

Taxonomy

Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
Primary
753893
TX

Other

Enumeration date
10/12/2017
Last updated
10/12/2017
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