Healthcare Provider Details

I. General information

NPI: 1093777971
Provider Name (Legal Business Name): FRANCISCO CESAR DOMINICCI RN, BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DR. MARY WALKER CLINIC BLDG 170 ROOM 412
FORT IRWIN CA
92310
US

IV. Provider business mailing address

PO BOX 10820
FORT IRWIN CA
92310-0820
US

V. Phone/Fax

Practice location:
  • Phone: 760-380-5414
  • Fax:
Mailing address:
  • Phone: 760-386-4079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number648787
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: