Individual
AMANDA ANTOINETTE DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1240 S WESTLAKE BLVD STE 205, WESTLAKE VILLAGE, CA 91361-1992
(805) 495-0551
Mailing address
6584 PINNACLE CT, MOORPARK, CA 93021-1272
(310) 270-3716
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA17489
CA
Other
Enumeration date
07/05/2020
Last updated
07/05/2020
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