Provider Demographics
NPI:1164286787
Name:DOMINGUEZ, CASSANDRA A
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:A
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 FERNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237-1749
Mailing Address - Country:US
Mailing Address - Phone:956-652-3296
Mailing Address - Fax:
Practice Address - Street 1:1430 FERNWOOD DR
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237-1749
Practice Address - Country:US
Practice Address - Phone:956-652-3296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND99954376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide