Healthcare Provider Details

I. General information

NPI: 1962264200
Provider Name (Legal Business Name): DOMINIQUE LEKANDER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 S WINCHESTER BLVD STE 102
SAN JOSE CA
95128-3911
US

IV. Provider business mailing address

244 MADISON AVE STE 141
NEW YORK NY
10016-2817
US

V. Phone/Fax

Practice location:
  • Phone: 669-201-0667
  • Fax: 308-646-6140
Mailing address:
  • Phone: 669-201-0667
  • Fax: 818-616-6046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95451197
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: