Eduardo Jose Dominguez, SA-C
Specialist/Technologist, Other, Surgical Assistant in Fairfax, VA. Individual provider (NPI-1).
NPI number1982195939
StatusActive
Last updated in NPPESMar 1, 2019
Details
- NPI
- 1982195939
- Entity type
- Individual (NPI-1)
- Name
- Eduardo Jose Dominguez
- Credential
- SA-C
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- May 25, 2018
- Last updated
- Mar 1, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 246ZC0007X | Specialist/Technologist, Other, Surgical Assistant | 12-135 | WI | Yes |
Practice location
12011 Lee Jackson Memorial HwyFairfax, VA 22033
Phone 703-349-1379 · Fax 214-764-0880
Mailing address
Po Box 221135Chantilly, VA 20153-1135
Phone 703-349-1379
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