Healthcare Provider Details

I. General information

NPI: 1548633423
Provider Name (Legal Business Name): GREGORIO DOMINGUEZ HHP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2015
Last Update Date: 11/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

746 S MAIN AVE STE D
FALLBROOK CA
92028-3352
US

IV. Provider business mailing address

746 S MAIN AVE STE D
FALLBROOK CA
92028-3352
US

V. Phone/Fax

Practice location:
  • Phone: 760-728-8999
  • Fax: 760-728-0821
Mailing address:
  • Phone: 760-728-8999
  • Fax: 760-728-0821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number46608
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: