Active NPI
Olma Dominguez, 1184
- Rehabilitation Practitioner
- Albuquerque, NM
National Provider Identifier
1508980145
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- License
- 1184
- Practice address
- 1111 Menaul Blvd NE
Albuquerque, NM 87107-1614 - Phone
- (505) 255-5501
- Fax
- (505) 255-9971
- NPI assigned
- Mar 19, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Rehabilitation Practitioner | 225400000X | 1184 | NM | Primary |
Addresses
Primary practice location
1111 Menaul Blvd NE
Albuquerque, NM 87107-1614
Mailing address
1111 Menaul Blvd NE
Albuquerque, NM 87107-1614
Phone (505) 255-5501
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 |
|---|---|---|---|
| 1184 | NM | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174262400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1508980145",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1111 MENAUL BLVD NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871071614",
"telephone_number": "505-255-5501",
"fax_number": "505-255-9971"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1111 MENAUL BLVD NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871071614",
"telephone_number": "505-255-5501",
"fax_number": "505-255-9971"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMINGUEZ",
"first_name": "OLMA",
"name_prefix": "Ms.",
"credential": "1184",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": "NM",
"license": "1184",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.