| NPI | 1649886292 |
|---|---|
| Former Name | JESSICA ELIZABETH DOMINGUEZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX PA13973) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2020-09-18 |
| Last Update Date | 2022-10-03 |