Individual provider · Type 1 NPI

Leonardo Daniel Dominguez

Student in an Organized Health Care Education/Training Program · Forest Grove, OR

NPI number 1811565203 Active

Practice location

2043 College Way
Forest Grove, OR 97116-1756

Call (503) 352-6151 Map

Mailing address

1114 NW 92nd Ave
Portland, OR 97229-5339

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1811565203

Leonardo Daniel Dominguez's National Provider Identifier is 1811565203, issued on Jun 14, 2021. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Forest Grove, OR. The record was last updated on Jun 14, 2021.