Provider Demographics
NPI:1023480159
Name:DOMINGUEZ, ISAAC (PA-C)
Entity type:Individual
Prefix:MR
First Name:ISAAC
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 HOWE AVE STE 440
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-1098
Mailing Address - Country:US
Mailing Address - Phone:916-569-8484
Mailing Address - Fax:
Practice Address - Street 1:5385 FRANKLIN BLVD STE K
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-4717
Practice Address - Country:US
Practice Address - Phone:916-569-8484
Practice Address - Fax:530-661-1027
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA52837363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant