Guadalupe R Dominguez, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA849 Issued in NV

Practice address

1905 Civic Center Dr
North Las Vegas, NV 89030-7143

Phone

(702) 877-9514

Fax

(702) 312-3510

NPI assigned

Oct 11, 2005

Last updated

Nov 18, 2020By the provider in NPPES

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 identifiers 1

Medicare fee-for-service enrollment

Enrolled in NV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Vishal Gandotra MD IncGroup PAC ID 6800955410, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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

• Vishal Gandotra MD PC

  dba Vishal Gandotra MD Inc

  • Gastroenterology Physician
  • Las Vegas, NV
  • NPI 1083864177
  Medicare reassignment Care Compare group
• Rd Prabhu-Lata K Shete MDS LTD

  • Multi-Specialty Clinic/Center
  • Las Vegas, NV
  • NPI 1912995309
  Medicare reassignment NPD
• Centerwell Senior Primary Care NV P C

  dba CenterWell Senior Primary Care-Spring Valley

  • Internal Medicine Physician
  • Las Vegas, NV
  • NPI 1285257667
  Medicare reassignment
• Centerwell Senior Primary Care (NV) PC

  dba CenterWell Senior Primary Care-Green Valley

  • Internal Medicine Physician
  • Las Vegas, NV
  • NPI 1053029488
  NPD
• Centerwell Senior Primary Care (NV) PC

  dba CenterWell Senior Primary Care-South Nellis

  • Internal Medicine Physician
  • Las Vegas, NV
  • NPI 1306469788
  NPD
• Rd Prabhu-Lata K Shete MDS LTD

  dba The Sleep Centers of Nevada

  • Sleep Disorder Diagnostic Clinic/Center
  • Henderson, NV
  • NPI 1790144897
  NPD
• Jose G Veliz M.D. Inc.

  • Anesthesiology Physician
  • Poway, CA
  • NPI 1770689028
  NPD (past)

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

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605657600000",
    "number": "1649268913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5701 W CHARLESTON BLVD",
            "address_2": "SUITE 100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891461217",
            "telephone_number": "702-312-3444",
            "fax_number": "702-312-3510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1905 CIVIC CENTER DR",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890307143",
            "telephone_number": "702-877-9514",
            "fax_number": "702-312-3510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINGUEZ",
        "first_name": "GUADALUPE",
        "middle_name": "R",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-11",
        "last_updated": "2020-11-18",
        "certification_date": "2020-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NV",
            "license": "PA849",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1649268913",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Leslie Domingo, PHARMD
• Ana Dominguez Castellon
• Kathie Dominguez Castellon
• Maray Dominguez Llerena
• Amalia Dominguez
• Donald I Kuzyk DPM Inc
• Donald Posson, PH.D., Ladc (Retreat, Respite, Re-Create)
• Amayah Dondle
• Davion Donely
• Brenda Doroteo

• Physician Assistant in North Las Vegas, NV
• Providers in North Las Vegas, NV by specialty
• Physician Assistant in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.