Healthcare Provider Details

I. General information

NPI: 1114046596
Provider Name (Legal Business Name): ESTELA DOMINGO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 WILLIAMS DR 110
OXNARD CA
93036-2612
US

IV. Provider business mailing address

1107 BRIANA CIR
OXNARD CA
93030-6081
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-4200
  • Fax: 805-981-3351
Mailing address:
  • Phone: 805-469-6494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number601681
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: