Active NPI
John Anthony Dominguez
- Family Medicine Physician
- Phoenix, AZ
National Provider Identifier
1588897359
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 3887
- Practice address
- 150 S. 12 Street
Phoenix, AZ 85034-2301 - Phone
- (602) 495-5797
- Fax
- (602) 262-6201
- NPI assigned
- Aug 27, 2009
- Last updated
- May 15, 2024
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 3887 | AZ | Primary |
Addresses
Primary practice location
150 S. 12 Street
Phoenix, AZ 85034-2301
Mailing address
3746 Foothill Blvd B140
Glendale, CA 91214
Phone (602) 495-5797
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)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3887 | AZ | MD | Clinical Psychologist |
Interoperability endpoints
- john.dominguez.1@5834.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1251331200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715731200000",
"number": "1588897359",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3746 FOOTHILL BLVD B140",
"city": "GLENDALE",
"state": "CA",
"postal_code": "91214",
"telephone_number": "602-495-5797",
"fax_number": "602-262-6201"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "150 S. 12 STREET",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850342301",
"telephone_number": "602-495-5797",
"fax_number": "602-262-6201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMINGUEZ",
"first_name": "JOHN",
"middle_name": "ANTHONY",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-08-27",
"last_updated": "2024-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AZ",
"license": "3887",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.