Individual
ALODIA BANUELOS DOMINGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
5700 W OLIVE AVE STE 102, GLENDALE, AZ 85302
(623) 738-6062
(602) 354-9462
Mailing address
5700 W OLIVE AVE STE 102, GLENDALE, AZ 85302-3147
(623) 738-6062
(602) 354-9462
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN135342
AZ
363LF0000X
Family Nurse Practitioner
Primary
AP5625
AZ
Other
Enumeration date
02/26/2014
Last updated
04/23/2021
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