Provider Demographics
NPI:1396312328
Name:DOMINGO, ROGELLYN SOLIZA (FNP-C)
Entity type:Individual
Prefix:
First Name:ROGELLYN
Middle Name:SOLIZA
Last Name:DOMINGO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5960 MISSION CENTER RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-3863
Mailing Address - Country:US
Mailing Address - Phone:805-512-0283
Mailing Address - Fax:
Practice Address - Street 1:5960 MISSION CENTER RD UNIT B
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-3863
Practice Address - Country:US
Practice Address - Phone:805-512-0283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017035363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily