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General NPI Number Information
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NPI Number | 1588685226
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Entity Type | Individual
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Provider Name | FRENALYN BACATE DOMINGO NP
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Gender | Female
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 11/23/2021
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Provider Practice Location Address
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Address Line | 22040 VAN BUREN ST
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City | GRAND TERRACE
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State | CA
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Zip | 92313
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Country | US
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Telephone | 909-677-7850
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Fax | 909-494-7542
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Provider Business Mailing Address
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Address Line | 25612 BARTON RD 335
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City | LOMA LINDA
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State | CA
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Zip | 92354-3110
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Country | US
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Telephone | 909-709-7941
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP 13242
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License Number State | CA
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