Provider Demographics
NPI:1588685226
Name:DOMINGO, FRENALYN BACATE (NP)
Entity Type:Individual
Prefix:MRS
First Name:FRENALYN
Middle Name:BACATE
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 1:25612 BARTON RD
Mailing Address - Street 2:335
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3110
Mailing Address - Country:US
Mailing Address - Phone:909-709-7941
Mailing Address - Fax:
Practice Address - Street 1:22040 VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:GRAND TERRACE
Practice Address - State:CA
Practice Address - Zip Code:92313
Practice Address - Country:US
Practice Address - Phone:909-677-7850
Practice Address - Fax:909-494-7542
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 13242363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner