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General NPI Number Information
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NPI Number | 1740870211
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Entity Type | Individual
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Provider Name | DAVID ARTURO DOMINGUEZ PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/19/2021
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 100 CHERRY ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-4526
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Country | US
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Telephone | 616-965-8200
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Fax | 616-940-5337
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Provider Business Mailing Address
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Address Line | 100 CHERRY ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-4526
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Country | US
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Telephone | 616-776-2400
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Fax | 616-940-5337
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9244
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601012911
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License Number State | MI
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