Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 169091 | CA |
NPI | 1114339942 |
---|---|
Provider Name | Dr. Dominick John Gadaleta |
First Address | Palo Alto, CA 94306-1165 |
Second Address | Palo Alto, CA 94306-1165 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2014 |
Last Update Date | 20/11/2020 |