Healthcare Provider Details

I. General information

NPI: 1003401837
Provider Name (Legal Business Name): DOMINGUEZ SCHALCH LEPE KABACK GUARNERI MEDICAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2021
Last Update Date: 03/03/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1349 CAMINO DEL MAR F
DEL MAR CA
92014
US

IV. Provider business mailing address

1349 CAMINO DEL MAR F
DEL MAR CA
92014
US

V. Phone/Fax

Practice location:
  • Phone: 858-755-1166
  • Fax:
Mailing address:
  • Phone: 858-755-1166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISTINA TURCO
Title or Position: BILLING MANGER
Credential:
Phone: 619-850-5683