Healthcare Provider Details

I. General information

NPI: 1700797925
Provider Name (Legal Business Name): RAQUEL DOMINGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 S MIDLAND AVE UNIT P1
KEARNY NJ
07032-1677
US

IV. Provider business mailing address

20 S MIDLAND AVE UNIT P1
KEARNY NJ
07032-1677
US

V. Phone/Fax

Practice location:
  • Phone: 201-675-6041
  • Fax:
Mailing address:
  • Phone: 201-675-6041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number26NR20353400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: