Provider Demographics
NPI:1619598943
Name:DOMINGUEZ, CLAUDIA VERONICA (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:VERONICA
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 E YANDELL DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5529
Mailing Address - Country:US
Mailing Address - Phone:915-534-7979
Mailing Address - Fax:915-534-7601
Practice Address - Street 1:721 S OCHOA ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79901-2935
Practice Address - Country:US
Practice Address - Phone:915-545-7090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145581363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty