Provider Demographics
NPI:1023797321
Name:AMPARANO, DOMINICK REY
Entity type:Individual
Prefix:
First Name:DOMINICK
Middle Name:REY
Last Name:AMPARANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 SPRINGFIELD CT
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-2422
Mailing Address - Country:US
Mailing Address - Phone:415-720-6489
Mailing Address - Fax:
Practice Address - Street 1:18300 ROSCOE BLVD
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4167
Practice Address - Country:US
Practice Address - Phone:818-885-8500
Practice Address - Fax:818-727-0893
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025957363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily