Provider Demographics
NPI:1083296016
Name:GIRON-DOMINGUEZ, BEATRIZ (PA-C)
Entity Type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:
Last Name:GIRON-DOMINGUEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 E BLACK BRUSH DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-3180
Mailing Address - Country:US
Mailing Address - Phone:602-432-1880
Mailing Address - Fax:
Practice Address - Street 1:2276 E RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2636
Practice Address - Country:US
Practice Address - Phone:435-986-2565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
UT13600489-1206207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program