Individual
GUERDA DOMINIQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
11 NEVINS ST STE 306, BRIGHTON, MA 02135-3514
(617) 414-4505
Mailing address
960 MASSACHUSETTS AVE STE 2, BOSTON, MA 02118-2690
(617) 414-4505
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0110001307
VA
363A00000X
Physician Assistant
C01930
MD
363A00000X
Physician Assistant
Primary
PA8505
MA
363AS0400X
Surgical Physician Assistant
PA200001547
DC
Other
Enumeration date
08/14/2006
Last updated
03/26/2025
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