Individual provider Active NPI

Pamela S Domino, RN

  • Registered Nurse
  • Santa Rosa, CA
National Provider Identifier
1356421051
Registry record updated May 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
533902 Issued in CA
Practice address
983 Sonoma Ave
Santa Rosa, CA 95404
Phone
(707) 583-8700
Fax
(707) 303-4066
NPI assigned
Oct 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 29, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 533902 CA Primary

Addresses

Primary practice location

983 Sonoma Ave
Santa Rosa, CA 95404

Mailing address

983 Sonoma Ave
Santa Rosa, CA 95404
Phone (707) 583-8700

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
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
533902CAMDRegistered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401321600000",
    "number": "1356421051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "983 SONOMA AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "95404",
            "telephone_number": "707-583-8700",
            "fax_number": "707-303-4066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "983 SONOMA AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "95404",
            "telephone_number": "707-583-8700",
            "fax_number": "707-303-4066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINO",
        "first_name": "PAMELA",
        "middle_name": "S",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-17",
        "last_updated": "2014-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "533902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2014; 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.