Most Relevant Information
Provider Data
| NPI Number: | 1003415563 |
| Provider Name: | SANJUANITA DOMINGUEZ |
| Entity Type: | Individual |
| Taxonomy Code: | 3747P1801X |
| Specialty: | Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 10/25/2020 |
| Last Updated: | 10/25/2020 |
Provider Practice Location
875 34TH AVE E APT 314
WEST FARGO
ND
580788051
Practice Location Phone/Fax
| Phone: | 7018851868 |
| Fax: |
Provider Mailing Location
875 34TH AVE E APT 314
WEST FARGO
ND
580788051
Provider Mailing Phone/Fax
| Phone: | 7018851868 |
| Fax: |