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NPI Code Detail

MEDICARE: PETE PASCUALE DOMINGUEZ JR.

MEDICARE: PETE PASCUALE DOMINGUEZ JR.
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1891152252
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETE PASCUALE DOMINGUEZ JR.
Provider Business Mailing Address
First Line : 3 E MAIN ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73104-2405
Country : US
Telephone Number : 405-639-2054
Fax Number : 405-639-3077
Provider Business Practice Location Address
First Line : 3 E MAIN ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73104-2405
Country : US
Telephone Number : 405-639-2054
Fax Number : 405-639-3077
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2016
Last Update Date : 01/15/2016

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