MEDICARE: DANIELLE DOMINGUEZ-RODRIGUEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	702137	CA

General Provider Information

NPI Number	:	1891344008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE DOMINGUEZ-RODRIGUEZ

Provider Business Mailing Address
First Line	:	11 CREEKSIDE DR UNIT 232
Second Line	:
City	:	SAN MARCOS
State	:	CA
Zip	:	92078-2352
Country	:	US
Telephone Number	:	619-715-5288
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 CREEKSIDE DR UNIT 232
Second Line	:
City	:	SAN MARCOS
State	:	CA
Zip	:	92078-2352
Country	:	US
Telephone Number	:	619-715-5288
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2019
Last Update Date	:	09/10/2019

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