1164088514 NPI number — MRS. CINDY PRISCILLA DOMINGUEZ ACNPC-AG

Table of content: MRS. CINDY PRISCILLA DOMINGUEZ ACNPC-AG (NPI 1164088514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164088514 NPI number — MRS. CINDY PRISCILLA DOMINGUEZ ACNPC-AG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOMINGUEZ
Provider First Name:
CINDY
Provider Middle Name:
PRISCILLA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ACNPC-AG
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VALDEZ SMITH
Provider Other First Name:
CINDY
Provider Other Middle Name:
PRISCILLA
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164088514
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
634 SW MULVANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOPEKA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66606-2224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-272-2240
Provider Business Mailing Address Fax Number:
785-272-2250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
634 SW MULVANE ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOPEKA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66606-1678
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-272-2240
Provider Business Practice Location Address Fax Number:
785-272-2250
Provider Enumeration Date:
05/11/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  78698 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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