MR. SAMUEL DOMINGO MSN, FNP
NPI 1063254910
Nurse Practitioner - Family in Laguna Hills, CA

Q: What is Samuel Domingo's NPI number?

The NPI number for Samuel Domingo is 1063254910. It was assigned to this individual provider in the NPPES registry on June 11, 2024.

Q: What is Samuel Domingo's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Samuel Domingo was last updated on March 13, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since June 11, 2024PECOS Enrolled

24012 CALLE DE LA PLATA STE 120, LAGUNA HILLS, CA 92653(949) 588-7246 Get Directions Write a Review

NPPES record last updated: March 13, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 13, 2026, Jun 11, 2024 (2 updates tracked since 2024).

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About Mr. Samuel Domingo Msn, Fnp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. SAMUEL DOMINGO MSN, FNP (NPI 1063254910) is an individual family provider in Laguna Hills, California, licensed in California (95029993) and active in the NPI registry since June 2024. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1063254910

Entity TypeIndividualMale

Primary Taxonomy363LF0000X

Provider Legal NameMR. SAMUEL DOMINGOCredential: MSN, FNP

Location Address24012 CALLE DE LA PLATA STE 120Laguna Hills, CA 92653-3632

Mailing Address2119 PendioIrvine, CA 92620-1760 · (562) 540-6633

Phone(949) 588-7246

Sole ProprietorYes

Enumeration DateJune 11, 2024

Last NPPES UpdateMarch 13, 20262 updates tracked since enumeration

NPPES CertifiedMarch 13, 2026

✔ NPI 1063254910 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in CA · 95029993

24012 CALLE DE LA PLATA STE 120, Laguna Hills, CA 92653

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Samuel Domingo Msn, Fnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92653 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$96.36 typical visit price

range $62.96 – $187.60

Typical copayment $24.09 (range $15.74 – $46.90)

Most-billed visit code 99203

Established Patient

$109.96 typical visit price

range $20.84 – $153.61

Typical copayment $27.49 (range $5.21 – $38.40)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. AMIR ABBAS POURADIB M.D.

Anesthesiology (Pain Medicine)