Provider Demographics
NPI:1194425140
Name:DOMINGUEZ, ROCIO AYLINNE
Entity type:Individual
Prefix:
First Name:ROCIO
Middle Name:AYLINNE
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3538 FRENCHPARK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-7323
Mailing Address - Country:US
Mailing Address - Phone:614-843-3916
Mailing Address - Fax:
Practice Address - Street 1:3538 FRENCHPARK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-7323
Practice Address - Country:US
Practice Address - Phone:614-843-3916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care