MEDICARE: NATALIA 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		NJ

General Provider Information

NPI Number	:	1669338661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIA DOMINGUEZ PA-C

Provider Business Mailing Address
First Line	:	144 MAPLEWOOD AVE
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-5134
Country	:	US
Telephone Number	:	201-957-6704
Fax Number	:

Provider Business Practice Location Address
First Line	:	99 HIGHWAY 37 W
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08755-6423
Country	:	US
Telephone Number	:	732-557-8080
Fax Number	:

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

Provider Enumeration Date	:	01/02/2026
Last Update Date	:	01/05/2026

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