Provider Demographics
NPI:1821247636
Name:DOMINGO, NAOMI NANQUIL (RN)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:NANQUIL
Last Name:DOMINGO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 827 BOX 170
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09617-1700
Mailing Address - Country:US
Mailing Address - Phone:39081-811-6000
Mailing Address - Fax:
Practice Address - Street 1:PSC 827
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09617-1700
Practice Address - Country:US
Practice Address - Phone:081-811-6292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2440163W00000X
CA600641364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA600641OtherBOARD OF REGISTERED NURSING
CA2440OtherBOARD OF REGISTERED NURSING