Provider Demographics
NPI:1912330028
Name:DOMINGUEZ, ARACELI A (CERTIFICATE)
Entity Type:Individual
Prefix:
First Name:ARACELI
Middle Name:A
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:CERTIFICATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 284
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-0045
Mailing Address - Country:US
Mailing Address - Phone:509-793-4208
Mailing Address - Fax:
Practice Address - Street 1:5932 ROAD 4.3 NE
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-7605
Practice Address - Country:US
Practice Address - Phone:509-793-4208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC7319171R00000X
WAMC10140171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter