1831579267 NPI number — DEBBIE ANN DOMINQUEZ-WIGGINS BSC.

Table of content: DEBBIE ANN DOMINQUEZ-WIGGINS BSC. (NPI 1831579267)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831579267 NPI number — DEBBIE ANN DOMINQUEZ-WIGGINS BSC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOMINQUEZ-WIGGINS
Provider First Name:
DEBBIE
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BSC.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WIGGINS
Provider Other First Name:
DEBBIE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
BSC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1831579267
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1296 LOHRMAN LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PETALUMA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94952-1650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-290-1899
Provider Business Mailing Address Fax Number:
707-776-4794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1296 LOHRMAN LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PETALUMA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94952-1650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-290-1899
Provider Business Practice Location Address Fax Number:
707-776-4794
Provider Enumeration Date:
06/01/2015

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: 175T00000X , with the licence number:  MPSS-YDOLQH , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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