Healthcare Provider Details

I. General information

NPI: 1386463677
Provider Name (Legal Business Name): KATRINA JOY DOMINGO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2024
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 J ST
CHULA VISTA CA
91910-5831
US

IV. Provider business mailing address

821 CAMINITO CUMBRES
CHULA VISTA CA
91911-7058
US

V. Phone/Fax

Practice location:
  • Phone: 858-554-1212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA65137
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: