Provider Demographics
NPI:1407526841
Name:LIGGINS, DOMINIQUE ALEXIS
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:ALEXIS
Last Name:LIGGINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 S AMPHLETT BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2711
Mailing Address - Country:US
Mailing Address - Phone:650-639-6949
Mailing Address - Fax:
Practice Address - Street 1:1700 S AMPHLETT BLVD STE 120
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2711
Practice Address - Country:US
Practice Address - Phone:650-639-6849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker