Provider Demographics
NPI:1033931191
Name:DOMINGUEZ GUERRERO, DRIALIS (MT)
Entity type:Individual
Prefix:
First Name:DRIALIS
Middle Name:
Last Name:DOMINGUEZ GUERRERO
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 SNAKE RIVER RD STE D
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-7746
Mailing Address - Country:US
Mailing Address - Phone:346-546-9653
Mailing Address - Fax:832-626-3627
Practice Address - Street 1:1808 SNAKE RIVER RD STE D
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-7746
Practice Address - Country:US
Practice Address - Phone:346-546-9653
Practice Address - Fax:832-626-3627
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT141910225700000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist