Individual
MIRIAM NOELLE DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
10750 COLUMBIA PIKE UNIT 401A, SILVER SPRING, MD 20901-4402
(301) 593-6072
Mailing address
10750 COLUMBIA PIKE UNIT 401A, SILVER SPRING, MD 20901-4402
(301) 593-6072
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
C07137
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1158970
NCCPA
—
01
—
C07137
MARYLAND BOARD OF PHYSICIANS
MD
Enumeration date
09/02/2019
Last updated
02/28/2021
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