Eduardo Jose Dominguez, SA-C

Primary specialty

Surgical AssistantTaxonomy code 246ZC0007X

License

12-135 Issued in WI

Practice address

12011 Lee Jackson Memorial Hwy
Fairfax, VA 22033

Phone

(703) 349-1379

Fax

(214) 764-0880

NPI assigned

May 25, 2018

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1527206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551398400000",
    "number": "1982195939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 221135",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201531135",
            "telephone_number": "703-349-1379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12011 LEE JACKSON MEMORIAL HWY",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "22033",
            "telephone_number": "703-349-1379",
            "fax_number": "214-764-0880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINGUEZ",
        "first_name": "EDUARDO",
        "middle_name": "JOSE",
        "credential": "SA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-05-25",
        "last_updated": "2019-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "WI",
            "license": "12-135",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elissa Dolina, PSY.D.
• Taylor Dollins, BCBA
• Mark Christian Domanski, M.D.
• Domingo Suatengco, MD, PC
• Melanie Giselle Dominguez Felix
• Dominion Foot & Ankle Consultants PC
• Dominion Urological Consultants
• Theresa Donahoe, MS
• Eleni Donas-Mozingo, RBT
• Crystal Donelan, MD

• Surgical Assistant in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Surgical Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.