Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | G68741 | CA |
NPI | 1003801556 |
---|---|
Provider Name | Dr. Joseph J Dominguez |
First Address | Sacramento, CA 95866-0877 |
Second Address | Fairfield, CA 94533-3552 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2005 |
Last Update Date | 09/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G687410 | (05) | CA |
F37894 | (02) | CA |