Provider Demographics
NPI:1962875559
Name:ARMSTRONG, DOMETRIVES (MSN, FNP, PHN, RN)
Entity type:Individual
Prefix:PROF
First Name:DOMETRIVES
Middle Name:
Last Name:ARMSTRONG
Suffix:
Gender:F
Credentials:MSN, FNP, PHN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2819 CIELO CIRCULO UNIT 2
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-1746
Mailing Address - Country:US
Mailing Address - Phone:619-957-5284
Mailing Address - Fax:
Practice Address - Street 1:2819 CIELO CIRCULO UNIT 2
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915-1746
Practice Address - Country:US
Practice Address - Phone:619-957-5284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA497177163W00000X
CA15374163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse