Provider Demographics
NPI:1437454634
Name:DOMINIQUE, ASHLEY (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:
Last Name:DOMINIQUE
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 1:910 PRESIDIO AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3330
Mailing Address - Country:US
Mailing Address - Phone:269-967-4958
Mailing Address - Fax:
Practice Address - Street 1:285 N EL CAMINO REAL STE 117
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5384
Practice Address - Country:US
Practice Address - Phone:760-633-1000
Practice Address - Fax:760-753-8657
Is Sole Proprietor?:No
Enumeration Date:2011-01-19
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55347363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant