Healthcare Provider Details

I. General information

NPI: 1023797321
Provider Name (Legal Business Name): DOMINICK REY AMPARANO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18300 ROSCOE BLVD
NORTHRIDGE CA
91325-4167
US

IV. Provider business mailing address

409 SPRINGFIELD CT
BRENTWOOD CA
94513-2422
US

V. Phone/Fax

Practice location:
  • Phone: 818-885-8500
  • Fax: 818-727-0893
Mailing address:
  • Phone: 415-720-6489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95025957
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: