Healthcare Provider Details

I. General information

NPI: 1740647916
Provider Name (Legal Business Name): ZITA ALEJANDRA DOMINICIS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2016
Last Update Date: 01/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8202 FLORENCE AVE STE 101
DOWNEY CA
90240-3937
US

IV. Provider business mailing address

8202 FLORENCE AVE STE 101
DOWNEY CA
90240-3937
US

V. Phone/Fax

Practice location:
  • Phone: 562-861-8807
  • Fax:
Mailing address:
  • Phone: 562-861-8807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number65348
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: