Provider Demographics
NPI:1972728046
Name:DOMINGUEZ, REBECCA CONRAD (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:CONRAD
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:THERESE
Other - Last Name:CONRAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 6730
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-6730
Mailing Address - Country:US
Mailing Address - Phone:480-821-3600
Mailing Address - Fax:480-821-3610
Practice Address - Street 1:5656 S POWER RD
Practice Address - Street 2:SUITE 137
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-8487
Practice Address - Country:US
Practice Address - Phone:480-821-3616
Practice Address - Fax:480-857-2667
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA130955207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
9010088OtherABOG BOARD CERTFITIED
AZ231384Medicaid
AZ231384Medicaid
AZ135195Medicare PIN