Individual
LAURA LIDIA DOMINGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
361 TOWN CTR W, SANTA MARIA, CA 93458-5076
(805) 922-6581
Mailing address
735 SAGE CREST DR, SANTA MARIA, CA 93455-8004
(559) 310-4506
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
95010540
CA
Other
Enumeration date
12/20/2018
Last updated
12/20/2018
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