Ivan Dominguez

Primary specialty

DriverTaxonomy code 172A00000X

License

D5281191 Issued in CA

Practice address

824 Mount Ranier Way
El Dorado Hills, CA 95762-4449

Phone

(818) 519-3699

NPI assigned

Jul 3, 2024

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Golden Age Transportation LLC

  • Non-emergency Medical Transport (VAN)
  • El Dorado Hills, CA
  • NPI 1649076829
  NPD Authorized official

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

{
    "created_epoch": "1719964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720742400000",
    "number": "1629814116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "824 MOUNT RANIER WAY",
            "city": "EL DORADO HILLS",
            "state": "CA",
            "postal_code": "957624449",
            "telephone_number": "818-519-3699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "824 MOUNT RANIER WAY",
            "city": "EL DORADO HILLS",
            "state": "CA",
            "postal_code": "957624449",
            "telephone_number": "818-519-3699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINGUEZ",
        "first_name": "IVAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-07-03",
        "last_updated": "2024-07-12",
        "certification_date": "2024-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172A00000X",
            "taxonomy_group": "",
            "desc": "Driver",
            "state": "CA",
            "license": "D5281191",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hailey Dickison
• Dustin Mann Diel
• Bryler Danger Digman
• Dignity Health Medical Foundation
• Stephanie Amanda Dodge
• Donald R. Liberty, DDS, Inc.
• Mariya Donskova
• Ashley Dordevic
• Dr Niam Phan OD an Optometry Corporation
• Sara Dreher

• Driver in El Dorado Hills, CA
• Providers in El Dorado Hills, CA by specialty
• Driver in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 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.

Verify at the official NPI Registry.