Individual
EDUARDO JOSE DOMINGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SA-C
Contact information
Practice address
12011 LEE JACKSON MEMORIAL HWY, FAIRFAX, VA 22033
(703) 349-1379
(214) 764-0880
Mailing address
PO BOX 221135, CHANTILLY, VA 20153-1135
(703) 349-1379
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
12-135
WI
Other
Enumeration date
05/25/2018
Last updated
03/01/2019
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