Healthcare Provider Details

I. General information

NPI: 1073368510
Provider Name (Legal Business Name): KIMBERLY SHARAI DOMINGUEZ-RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2024
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 WALNUT AVE
SANTA CRUZ CA
95060-3900
US

IV. Provider business mailing address

109 PARKHURST CIR UNIT D
APTOS CA
95003-9968
US

V. Phone/Fax

Practice location:
  • Phone: 831-423-9444
  • Fax:
Mailing address:
  • Phone: 831-498-7338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: