Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | B01346 | NV |
NPI | 1164786109 |
---|---|
Provider Name | Dr. Dominique Katherine Pitaccio |
First Address | Las Vegas, NV 89130-3863 |
Second Address | Las Vegas, NV 89130-3863 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2012 |
Last Update Date | 25/06/2012 |