Individual
MARA J DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
2740 BENSLEY COMMONS BLVD, NORTH CHESTERFIELD, VA 23237-1723
(804) 780-0840
Mailing address
2740 BENSLEY COMMONS BLVD, NORTH CHESTERFIELD, VA 23237-1723
(804) 780-0840
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
0024172699
VA
Other
Enumeration date
06/26/2015
Last updated
06/02/2016
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