Active NPI
Amanda Kristen Dominguez
- Athletic Trainer
- Pacoima, CA
National Provider Identifier
1114596244
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2013
- Practice address
- 11005 Norris Ave # 43
Pacoima, CA 91331-2501 - Phone
- (818) 480-1144
- NPI assigned
- Jun 22, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2013 | CA | Primary |
Addresses
Primary practice location
11005 Norris Ave # 43
Pacoima, CA 91331-2501
Mailing address
11005 Norris Ave # 43
Pacoima, CA 91331-2501
Phone (818) 480-1144
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| XEH910101639 | Other | BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2013 | CA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1624320000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1624320000000",
"number": "1114596244",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11005 NORRIS AVE # 43",
"city": "PACOIMA",
"state": "CA",
"postal_code": "913312501",
"telephone_number": "818-480-1144"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11005 NORRIS AVE # 43",
"city": "PACOIMA",
"state": "CA",
"postal_code": "913312501",
"telephone_number": "818-480-1144"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMINGUEZ",
"first_name": "AMANDA",
"middle_name": "KRISTEN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-06-22",
"last_updated": "2021-06-22",
"certification_date": "2021-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "CA",
"license": "2013",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "XEH910101639",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Pacoima, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.