NPIMap

Individual provider Active NPI

Cristina Lisette Dominguez, ACNP

  • Acute Care Nurse Practitioner
  • El Paso, TX
National Provider Identifier
1720843824
Registry record updated Feb 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
1152358 Issued in TX
Practice address
11163 La Quinta PL Ste A200
El Paso, TX 79936-5257
Phone
(915) 218-6055
NPI assigned
Feb 19, 2024
Last updated
Feb 25, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 1152358 TX Primary

Addresses

Primary practice location

11163 La Quinta PL Ste A200
El Paso, TX 79936-5257

Mailing address

11163 La Quinta PL Ste A200
El Paso, TX 79936-5257
Phone (915) 218-6055

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240403003808 TX Practitioner - Nurse Practitioner 2365880721 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Saurabh a Pande PAGroup PAC ID 7618237355, 7 clinicians

Practice addresses (Care Compare)

11163 La Quinta PL
Suite A200
El Paso, TX 79936-5257
Phone (915) 218-6055

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1152358TXMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Saurabh a Pande PA CurrentSince Mar 15, 2024 Accepting new patients
Iahiar PA PastSince Jun 14, 2019 Accepting new patients

Locations

10470 Vista del Sol Dr
Ste 105
El Paso, TX 79925
Phone (915) 218-6055

11163 La Quinta Pl
Ste A200
El Paso, TX 79936
Phone (915) 320-3854

9101 Dyer St
Ste 102
El Paso, TX 79924
Phone (915) 218-6055

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/18274/brand/1/csg/1/fhir/r4
  • FHIR API: https://api.platform.athenahealth.com/25296/brand/1/csg/1/fhir/r4

Organizations & group practices 2

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1708300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708819200000",
    "number": "1720843824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11163 LA QUINTA PL STE A200",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799365257",
            "telephone_number": "915-218-6055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11163 LA QUINTA PL STE A200",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799365257",
            "telephone_number": "915-218-6055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINGUEZ",
        "first_name": "CRISTINA",
        "middle_name": "LISETTE",
        "credential": "ACNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-19",
        "last_updated": "2024-02-25",
        "certification_date": "2024-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "1152358",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in El Paso, TX

Sources for this page

Verify at the official NPI Registry.