Individual
LAURA MARIE DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
300 S NOLEN DR STE 100, SOUTHLAKE, TX 76092-8057
(817) 989-2400
Mailing address
300 S NOLEN DR STE 100, SOUTHLAKE, TX 76092-8057
(817) 989-2400
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
P9329
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
336345901
—
TX
01
—
336345902
CSHCN
TX
Enumeration date
06/15/2009
Last updated
11/20/2024
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