Dominguez, Miranda

Dominguez, Miranda is an individual health care provider with primary practice located at 530 Ne Glen Oak Ave , Peoria IL 61637-0001. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Critical Care Medicine, which is considered as her primary health care specialty. Dominguez, Miranda can be contacted via phone (309) 655-2000.

Contact Information

Primary practice address
530 Ne Glen Oak Ave Peoria IL 61637-0001
Phone: (309) 655-2000
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Critical Care Medicine 363LC0200X 209.036661 Illinois

Profile Details

NPI number 1528972775
LBN Legal business name Dominguez, Miranda
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 2nd, 2026
Last updated Oct 2nd, 2026 - about last week

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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