Individual
JUAN CARLOS DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12430 PASEO BLANCO DR, EL PASO, TX 79928-5681
(915) 588-8513
Mailing address
12430 PASEO BLANCO DR, EL PASO, TX 79928-5681
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
138389
TX
Other
Enumeration date
07/27/2018
Last updated
07/27/2018
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