Provider Demographics
NPI:1649972530
Name:DOMINICK, PATIENCE
Entity type:Individual
Prefix:
First Name:PATIENCE
Middle Name:
Last Name:DOMINICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 N WASHINGTON ST STE E
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5651
Mailing Address - Country:US
Mailing Address - Phone:209-703-0723
Mailing Address - Fax:
Practice Address - Street 1:171 N WASHINGTON ST STE E
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5651
Practice Address - Country:US
Practice Address - Phone:209-703-0723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174H00000X, 374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174H00000XOther Service ProvidersHealth Educator