Provider Demographics
NPI:1538398144
Name:DOMINGUEZ MOLINA, NADIA VANESSA (MD)
Entity type:Individual
Prefix:
First Name:NADIA
Middle Name:VANESSA
Last Name:DOMINGUEZ MOLINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:ONE CHILDREN'S HOSPITAL DRIVE 4401 PENN AVE
Mailing Address - Street 2:DIVISION OF NEUROLOGY
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-0000
Mailing Address - Country:US
Mailing Address - Phone:412-692-8844
Mailing Address - Fax:412-692-3135
Practice Address - Street 1:ONE CHILDREN'S HOSPITAL DRIVE 4401 PENN AVE
Practice Address - Street 2:DIVISION OF NEUROLOGY
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-0000
Practice Address - Country:US
Practice Address - Phone:412-692-8844
Practice Address - Fax:412-692-3135
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD125801208000000X
AZ390200000X
PAMD4624652084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500614671Medicaid