Healthcare Provider Details

I. General information

NPI: 1316048705
Provider Name (Legal Business Name): JOANNE MARIE DOMINGUEZ PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 LAS VEGAS BLVD N NELLIS AFB
NELLIS AFB NV
89191-6600
US

IV. Provider business mailing address

7875 STEAMBOAT SPRINGS CT
LAS VEGAS NV
89139-5786
US

V. Phone/Fax

Practice location:
  • Phone: 702-653-3213
  • Fax:
Mailing address:
  • Phone: 702-236-3586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16762
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: