Individual provider Active NPI

Fernando Alfonso Dominguez, MD

  • Infectious Disease Physician
  • San Ysidro, CA
National Provider Identifier
1972917672
Registry record updated Apr 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
A154708 Issued in CA
Practice address
4004 Beyer Blvd
San Ysidro, CA 92173-2007
Phone
(619) 662-4100
NPI assigned
Jun 20, 2014
Last updated
Apr 22, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease Physician 207RI0200X A154708 CA Primary

Addresses

Primary practice location

4004 Beyer Blvd
San Ysidro, CA 92173-2007

Mailing address

1601 Precision Park LN
San Ysidro, CA 92173-1345

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200903003546 CA Practitioner - Internal MedicinePractitioner - Infectious Disease 9133546146 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Infectious Disease
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Telemedicine Group PCGroup PAC ID 9830351824, 94 clinicians
Centro de Salud de la Comunidad de San Ysidro,Inc.Group PAC ID 6901709435, shared by 31 NPIs, 291 clinicians

Practice addresses (Care Compare)

3400 Douglas Blvd
Suite 170
Roseville, CA 95661-4281
Phone (916) 740-3721

4004 Beyer Blvd
San Ysidro, CA 92173-2007
Phone (619) 428-4463

4050 Beyer Blvd
San Ysidro, CA 92173-2007
Phone (619) 662-4100

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A154708CAMDInfectious Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Family Health Centers of San Diego, Inc CurrentSince Aug 31, 2020 Accepting new patients
Family Health Centers of San Diego, Inc Current Accepting new patients
Family Health Centers of San Diego Inc CurrentSince Aug 31, 2020 Accepting new patients
Tele-Medicine Services Ny, PLLC Internal Medicine PastSince Apr 27, 2025 Accepting new patients

Locations

1809 National Ave
San Diego, CA 92113
Phone (619) 515-2500

4094 4th Ave
San Diego, CA 92103
Phone (619) 515-2545

823 Gateway Center Way
San Diego, CA 92102
Phone (619) 515-2323

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: fdominguez58716@syhealth.direct-ci.com
  • Direct secure messaging: telemed2u.fernandodominguez@160918.advancedmd-direct.com

Organizations & group practices 5

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 1

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": "1403222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745280000000",
    "number": "1972917672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 PRECISION PARK LN",
            "city": "SAN YSIDRO",
            "state": "CA",
            "postal_code": "921731345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4004 BEYER BLVD",
            "city": "SAN YSIDRO",
            "state": "CA",
            "postal_code": "921732007",
            "telephone_number": "619-662-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINGUEZ",
        "first_name": "FERNANDO",
        "middle_name": "ALFONSO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-20",
        "last_updated": "2025-04-22",
        "certification_date": "2025-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "CA",
            "license": "A154708",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Ysidro, CA

Sources for this page

Verify at the official NPI Registry.