MEDICARE: MS. GABRIELA DOMINGUEZ PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1376425249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GABRIELA DOMINGUEZ PA-C

Provider Business Mailing Address
First Line	:	347 MOUNT PLEASANT AVE STE 103
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-2745
Country	:	US
Telephone Number	:	973-434-1426
Fax Number	:	973-498-0535

Provider Business Practice Location Address
First Line	:	347 MOUNT PLEASANT AVE STE 103
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-2745
Country	:	US
Telephone Number	:	973-434-1426
Fax Number	:	973-498-0535

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2025
Last Update Date	:	03/05/2026

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