Healthcare Provider Details

I. General information

NPI: 1336457902
Provider Name (Legal Business Name): MONIQUE ANTOINETTE WHITE-DOMINGUEZ D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MONIQUE ANTOINETTE WHITE D.O.

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 DUARTE RD
DUARTE CA
91010-3012
US

IV. Provider business mailing address

PO BOX 512185
LOS ANGELES CA
90051-0185
US

V. Phone/Fax

Practice location:
  • Phone: 626-256-4673
  • Fax:
Mailing address:
  • Phone: 626-775-3514
  • Fax: 626-218-5310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A11372
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number20A11372
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: