Provider Demographics
NPI:1215216916
Name:DOMINGO, KATE ALLISON GALVAN (NP)
Entity Type:Individual
Prefix:
First Name:KATE ALLISON
Middle Name:GALVAN
Last Name:DOMINGO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8765 AERO DRIVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1767
Mailing Address - Country:US
Mailing Address - Phone:858-541-0181
Mailing Address - Fax:858-430-0919
Practice Address - Street 1:8765 AERO DR
Practice Address - Street 2:STE 130
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1781
Practice Address - Country:US
Practice Address - Phone:858-541-0181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20788363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily