Provider Demographics
NPI:1346008075
Name:DOMINGO, KRISTINE ALBANIO (NP)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:ALBANIO
Last Name:DOMINGO
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:DOMINGO
Other - Last Name:ROQUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14344 LASSELLE ST APT 104
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-2958
Mailing Address - Country:US
Mailing Address - Phone:619-944-7156
Mailing Address - Fax:
Practice Address - Street 1:15248 ELEVENTH ST
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3704
Practice Address - Country:US
Practice Address - Phone:760-245-8691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95029290363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily