Healthcare Provider Details

I. General information

NPI: 1972728046
Provider Name (Legal Business Name): REBECCA CONRAD DOMINGUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECCA THERESE CONRAD MD

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5656 S POWER RD SUITE 137
GILBERT AZ
85295-8487
US

IV. Provider business mailing address

PO BOX 6730
CHANDLER AZ
85246-6730
US

V. Phone/Fax

Practice location:
  • Phone: 480-821-3616
  • Fax: 480-857-2667
Mailing address:
  • Phone: 480-821-3600
  • Fax: 480-821-3610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number130955
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: