Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 42464 | CA |
NPI | 1003173162 |
---|---|
Provider Name | Dr. Ester Lisa Pena Domingo |
First Address | Pleasanton, CA 94588-3485 |
Second Address | Pleasanton, CA 94588-3485 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2012 |
Last Update Date | 13/04/2012 |