Healthcare Provider Details

I. General information

NPI: 1184378952
Provider Name (Legal Business Name): JACOB ANTHONY DOMINGUEZ-GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 N MAIN ST STE 205
FALL RIVER MA
02720-2972
US

IV. Provider business mailing address

1565 N MAIN ST STE 205
FALL RIVER MA
02720-2972
US

V. Phone/Fax

Practice location:
  • Phone: 987-248-8938
  • Fax:
Mailing address:
  • Phone: 508-324-0328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: