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General NPI Number Information
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NPI Number | 1063254910
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Entity Type | Individual
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Provider Name | SAMUEL DOMINGO MSN, FNP
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Gender | Male
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Dates
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Enumeration Date | 06/11/2024
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Last Update Date | 03/13/2026
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Provider Practice Location Address
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Address Line | 24012 CALLE DE LA PLATA STE 120
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-3632
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Country | US
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Telephone | 949-588-7246
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Fax |
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Provider Business Mailing Address
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Address Line | 2119 PENDIO
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City | IRVINE
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State | CA
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Zip | 92620-1760
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Country | US
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Telephone | 562-540-6633
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95029993
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License Number State | CA
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