Provider Demographics
NPI:1457681405
Name:DOMINGO-RAZA, CLARE
Entity Type:Individual
Prefix:
First Name:CLARE
Middle Name:
Last Name:DOMINGO-RAZA
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 1:151 VAN HOUTEN AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-4429
Mailing Address - Country:US
Mailing Address - Phone:619-401-3635
Mailing Address - Fax:619-401-3600
Practice Address - Street 1:151 VAN HOUTEN AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-4429
Practice Address - Country:US
Practice Address - Phone:619-401-3635
Practice Address - Fax:619-401-3600
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA719323163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse