Individual
MARIAH PAZ DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
770 KENMOOR AVE SE STE 100, GRAND RAPIDS, MI 49546-8602
(616) 272-3533
(616) 259-4839
Mailing address
103 S JACKSON ST STE 200, JACKSON, MI 49201-2211
(517) 212-9000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
9111654
FL
Other
Enumeration date
10/25/2018
Last updated
06/07/2022
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