Provider Demographics
NPI:1427706779
Name:WENGERT, DOMINIK BRAYDEN
Entity type:Individual
Prefix:MR
First Name:DOMINIK
Middle Name:BRAYDEN
Last Name:WENGERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DOMINGO
Other - Middle Name:
Other - Last Name:ORGANISTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 GATEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-7401
Mailing Address - Country:US
Mailing Address - Phone:650-573-4799
Mailing Address - Fax:
Practice Address - Street 1:801 GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-7401
Practice Address - Country:US
Practice Address - Phone:650-573-4799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist