Healthcare Provider Details

I. General information

NPI: 1265023857
Provider Name (Legal Business Name): BLANCA ANGELICA VALLE DOMINGUEZ TRAINEE-CLINICAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BLANCA VALLE DOMINGUEZ TRAINEE-CLINICAL

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 PARAMOUNT BLVD
DOWNEY CA
90241-4530
US

IV. Provider business mailing address

11500 PARAMOUNT BLVD
DOWNEY CA
90241-4530
US

V. Phone/Fax

Practice location:
  • Phone: 562-923-4545
  • Fax:
Mailing address:
  • Phone: 562-923-4545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: