Healthcare Provider Details

I. General information

NPI: 1265491146
Provider Name (Legal Business Name): LINDA DOMINGUEZ CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

883 LEAD AVENUE SE SUITE A
ALB NM
87102
US

IV. Provider business mailing address

883 LEAD AVE SE STE A
ALBUQUERQUE NM
87102-3644
US

V. Phone/Fax

Practice location:
  • Phone: 505-843-7131
  • Fax: 505-246-9421
Mailing address:
  • Phone: 505-843-7131
  • Fax: 505-246-9421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberR20342
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: