Amanda Antoinette Dominguez, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA17489 Issued in CA

Practice address

1240 S Westlake Blvd Ste 205
Westlake Village, CA 91361-1992

Phone

(805) 495-0551

NPI assigned

Jul 5, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Amanda Antoinette Jensen Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1593907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593907200000",
    "number": "1265059307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6584 PINNACLE CT",
            "city": "MOORPARK",
            "state": "CA",
            "postal_code": "930211272",
            "telephone_number": "310-270-3716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1240 S WESTLAKE BLVD STE 205",
            "city": "WESTLAKE VILLAGE",
            "state": "CA",
            "postal_code": "913611992",
            "telephone_number": "805-495-0551"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "301 Science Dr Ste 280",
            "address_purpose": "LOCATION",
            "city": "Moorpark",
            "state": "CA",
            "postal_code": "930210803",
            "country_code": "US",
            "telephone_number": "805-530-7110",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOMINGUEZ",
        "first_name": "AMANDA",
        "middle_name": "ANTOINETTE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-05",
        "last_updated": "2020-07-05",
        "certification_date": "2020-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA17489",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "JENSEN",
            "middle_name": "ANTOINETTE",
            "credential": "PA-C",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Medical Physician Assistant in Westlake Village, CA
• Providers in Westlake Village, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.