Provider Demographics
NPI:1356422521
Name:DOMINGUEZ, DAVID ALAN (PA-C)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALAN
Last Name:DOMINGUEZ
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1525 W WINTON AVE
Mailing Address - Street 2:BLDG. # 9
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-1310
Mailing Address - Country:US
Mailing Address - Phone:510-750-3157
Mailing Address - Fax:510-293-1809
Practice Address - Street 1:101 BODIN CIRCLE
Practice Address - Street 2:DAVID GRANT MEDICAL CENTER
Practice Address - City:TRAVIS AFB
Practice Address - State:CA
Practice Address - Zip Code:94535-1800
Practice Address - Country:US
Practice Address - Phone:707-423-7611
Practice Address - Fax:707-423-3260
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA13224363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant