Healthcare Provider Details

I. General information

NPI: 1609459924
Provider Name (Legal Business Name): DOMINIQUE JOSEPH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 08/08/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 DEL MONTE LN STE 3
RENO NV
89511-7508
US

IV. Provider business mailing address

1155 MILL ST # M-14
RENO NV
89502-1576
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-5000
  • Fax:
Mailing address:
  • Phone: 775-982-5262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number27833
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberLL4376
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: