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General NPI Number Information
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NPI Number | 1982104154
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Entity Type | Individual
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Provider Name | ZORAIDA SOFIA DOMINGUEZ
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Gender | Female
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Dates
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Enumeration Date | 02/14/2018
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Last Update Date | 02/14/2018
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Provider Practice Location Address
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Address Line | 1951 STELLA LAKE ST STE 36
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City | LAS VEGAS
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State | NV
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Zip | 89106-2144
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Country | US
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Telephone | 702-595-1415
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Fax |
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Provider Business Mailing Address
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Address Line | 652 MACCABE AVE
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City | LAS VEGAS
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State | NV
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Zip | 89123-6234
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Country | US
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Telephone | 702-861-7991
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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 | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number | 1704551333
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License Number State | NV
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