MEDICARE: VICTOR GONZALEZ DOMINGUEZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A55866	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	050394	OTHER	CA	BLUE CROSS
3	1215903018	OTHER	CA	NPI
4	951683892	OTHER	CA	OTHER INSURANCE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710924006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTOR GONZALEZ DOMINGUEZ M.D.

Provider Business Mailing Address
First Line	:	5855 OLIVAS PARK DR
Second Line	:
City	:	VENTURA
State	:	CA
Zip	:	93003-7672
Country	:	US
Telephone Number	:	805-667-2801
Fax Number	:	805-667-2865

Provider Business Practice Location Address
First Line	:	242 E HARVARD BLVD
Second Line	:	SUITE C
City	:	SANTA PAULA
State	:	CA
Zip	:	93060-3372
Country	:	US
Telephone Number	:	805-525-9595
Fax Number	:	805-525-6667

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	12/26/2013

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