Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VX0201X | Gynecologic Oncologist | 131578 | OH |
Y | 207VX0201X | Gynecologic Oncologist | A133574 | CA |
NPI | 1043659634 |
---|---|
Provider Name | Christa Dominick |
First Address | Sacramento, CA 95865-5228 |
Second Address | Sacramento, CA 95816-5616 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2013 |
Last Update Date | 24/08/2020 |