| Provider / Organization | NPI | Date Certified |
|---|---|---|
| AMANDA ANTOINETTE DOMINGUEZ | 1265059307 | 2020-07-05 |
Amanda Antoinette Dominguez [F] graduated in 2003 and primarily specializes in Physician Assistant.
Amanda Antoinette Dominguez is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1265059307. Registration indicates Amanda Antoinette Dominguez is a provider of access to adult/geriatric primary care providers services with a specialization in Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (Physician Assistant: Medical, ) (All Other Specialties & Provider Types, ) (Physician Assistant Medical, Physician Assistants & Advanced Practice Nursing Providers) (Physician Assistant, )
| PECOS ID | 5991129298 |
| Registration | PART-B:Y DME:Y HHA:Y PMD:Y |
| Entity Type | Individual |
| Provider Name | Amanda Antoinette Dominguez PA-C |
| Other Provider Name | Amanda Antoinette Jensen |
| Practice Office Address | 1240 S WESTLAKE BLVD STE 205 WESTLAKE VILLAG, CA US |
| Practice Office Telephone | 8054950551 |
| Mailing Address | 6584 PINNACLE CT MOORPARK, CA 930211272 US |
| Business Telephone | 3102703716 |
| Address | City / State | Phone / Fax |
|---|---|---|
| 301 Science Dr Ste 280 | Moorpark, CA 930210803 | 8055307110 |
| Code | Practice | License No State |
|---|---|---|
| 363AM0700X PRIMARY | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician AssistantAccess to Pediatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician Assistant Physician Assistants & Advanced Practice Nursing Providers Physician Assistant Physician Assistant: Medical All Other Specialties & Provider Types Physician Assistant Medical Physician Assistants & Advanced Practice Nursing Providers Physician Assistant | PA17489
CA |