Provider Demographics
NPI:1598955023
Name:GLORIA, KRISTINA DOMINGUEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:DOMINGUEZ
Last Name:GLORIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:800 SWIFT BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-942-2268
Practice Address - Street 1:9605 SANDIFUR PARKWAY
Practice Address - Street 2:KADLEC CLINIC - PASCO PRIMARY CARE
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301
Practice Address - Country:US
Practice Address - Phone:509-942-3170
Practice Address - Fax:509-543-9795
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
WAMD60403068207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1598955023Medicaid