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General NPI Number Information
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NPI Number | 1407661846
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Entity Type | Individual
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Provider Name | KAYLA DOMINGUEZ
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Gender | Female
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Dates
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Enumeration Date | 02/12/2025
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 5983 S REDWOOD RD
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City | TAYLORSVILLE
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State | UT
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Zip | 84123-5261
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Country | US
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Telephone | 385-800-3015
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Fax |
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Provider Business Mailing Address
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Address Line | 235 E 9670 S
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City | SANDY
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State | UT
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Zip | 84070-3331
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Country | US
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Telephone |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 122985763102
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License Number State | UT
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