Provider Demographics
NPI:1083226104
Name:FLORES DOMINGUEZ, MARIA CRISTINA (PSS)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:CRISTINA
Last Name:FLORES DOMINGUEZ
Suffix:
Gender:F
Credentials:PSS
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:CRISTINA
Other - Last Name:DOMINGUEZ CRUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:944 W 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-5106
Mailing Address - Country:US
Mailing Address - Phone:541-687-2667
Mailing Address - Fax:
Practice Address - Street 1:944 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-5106
Practice Address - Country:US
Practice Address - Phone:541-687-2667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW2209175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist