Amanda Kristen Dominguez
Specialist/Technologist, Athletic Trainer in Pacoima, CA. Individual provider (NPI-1).
NPI number1114596244
StatusActive
Last updated in NPPESJun 22, 2021
Details
- NPI
- 1114596244
- Entity type
- Individual (NPI-1)
- Name
- Amanda Kristen Dominguez
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jun 22, 2021
- Certification date
- Jun 22, 2021
- Last updated
- Jun 22, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2255A2300X | Specialist/Technologist, Athletic Trainer | 2013 | CA | Yes |
Practice location
11005 Norris Ave # 43Pacoima, CA 91331-2501
Phone 818-480-1144
Mailing address
11005 Norris Ave # 43Pacoima, CA 91331-2501
Phone 818-480-1144
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