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General NPI Number Information
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NPI Number | 1629052436
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Entity Type | Individual
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Provider Name | DINO RAUL DOMINGUEZ JR. CRNA
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Gender | Male
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Dates
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Enumeration Date | 12/05/2005
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Last Update Date | 03/16/2026
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Provider Practice Location Address
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Address Line | 4212 N 16TH ST
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City | PHOENIX
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State | AZ
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Zip | 85016-5319
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Country | US
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Telephone | 602-263-1200
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Fax | 602-263-1619
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Provider Business Mailing Address
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Address Line | PO BOX 95460
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City | CLEVELAND
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State | OH
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Zip | 44101-0033
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Country | US
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Telephone | 602-581-6076
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Fax | 602-263-1619
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | CRNA0564
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN3150502
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | R168347
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License Number State | MD
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