Provider Demographics
NPI:1558335927
Name:DOMINGUEZ, SILVIA (NP)
Entity Type:Individual
Prefix:
First Name:SILVIA
Middle Name:
Last Name:DOMINGUEZ
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 1:4945 W CYPRESS AVE
Mailing Address - Street 2:STE C
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277
Mailing Address - Country:US
Mailing Address - Phone:559-624-3000
Mailing Address - Fax:559-635-4006
Practice Address - Street 1:4945 W CYPRESS AVE
Practice Address - Street 2:STE C
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277
Practice Address - Country:US
Practice Address - Phone:559-624-3000
Practice Address - Fax:559-635-4006
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15927363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA15927OtherSTATE LICENSE