Healthcare Provider Details

I. General information

NPI: 1518977560
Provider Name (Legal Business Name): FELICIDAD G LAO-DOMINGO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 03/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W 6TH ST SUITE I
GILROY CA
95020
US

IV. Provider business mailing address

700 W 6TH ST STE 1
GILROY CA
95020
US

V. Phone/Fax

Practice location:
  • Phone: 408-847-1166
  • Fax: 408-847-3045
Mailing address:
  • Phone: 408-847-1166
  • Fax: 408-847-3045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA33817
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: