Individual
JESSICA DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1135 MAIN AVE, CLIFTON, NJ 07011-2353
(973) 928-3388
Mailing address
187 HOPE AVE APT 2, PASSAIC, NJ 07055-6707
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
030723
NY
363A00000X
Physician Assistant
Primary
25MP00812900
NJ
Other
Enumeration date
10/18/2023
Last updated
12/27/2023
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