1093865909 NPI number — DR. EFIGENIA G DOMINGUEZ DC, QME

Table of content: DR. EFIGENIA G DOMINGUEZ DC, QME (NPI 1093865909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093865909 NPI number — DR. EFIGENIA G DOMINGUEZ DC, QME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOMINGUEZ
Provider First Name:
EFIGENIA
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC, QME
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093865909
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2369 OCEAN AVE
Provider Second Line Business Mailing Address:
2ND LEVEL
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94127-2615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-239-9700
Provider Business Mailing Address Fax Number:
408-292-9476

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2369 OCEAN AVE
Provider Second Line Business Practice Location Address:
2ND LEVEL
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94127-2615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-239-9700
Provider Business Practice Location Address Fax Number:
408-292-9476
Provider Enumeration Date:
01/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC 29049 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5694837 . This is a "FIRST HEALTH PROVIDER NO." identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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