Healthcare Provider Details

I. General information

NPI: 1912817958
Provider Name (Legal Business Name): RICHARD NUNEZ DOMINGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19003 W SHEFFER AVE
BUCKEYE AZ
85326-5739
US

IV. Provider business mailing address

19003 W SHEFFER AVE
BUCKEYE AZ
85326-5739
US

V. Phone/Fax

Practice location:
  • Phone: 602-585-5900
  • Fax:
Mailing address:
  • Phone: 602-585-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number227680
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: