Provider Demographics
NPI:1447688981
Name:DOMINGUEZ, VICTOR (AGACNP)
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:M
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 E CLIFF DR
Mailing Address - Street 2:BLDG A STE 200
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5192
Mailing Address - Country:US
Mailing Address - Phone:915-577-9009
Mailing Address - Fax:915-577-9006
Practice Address - Street 1:1700 E CLIFF DR
Practice Address - Street 2:BLDG A STE 200
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5192
Practice Address - Country:US
Practice Address - Phone:915-577-9009
Practice Address - Fax:915-577-9006
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-18
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP124616363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care