Provider Demographics
NPI:1043902729
Name:GUERRERO, DOMINIQUE (LDO, ABOC, NCLEC)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:
Last Name:GUERRERO
Suffix:
Gender:F
Credentials:LDO, ABOC, NCLEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4820 ROAD 68
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-9009
Mailing Address - Country:US
Mailing Address - Phone:509-543-7953
Mailing Address - Fax:509-543-7955
Practice Address - Street 1:4820 ROAD 68
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-9009
Practice Address - Country:US
Practice Address - Phone:509-543-7953
Practice Address - Fax:509-543-7955
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician