Healthcare Provider Details

I. General information

NPI: 1558566364
Provider Name (Legal Business Name): COMPLETE CARE FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26800 CROWN VALLEY PARKWAY SUITE 435
MISSION VIEJO CA
92691
US

IV. Provider business mailing address

26800 CROWN VALLEY PARKWAY SUITE 435
MISSION VIEJO CA
92691
US

V. Phone/Fax

Practice location:
  • Phone: 949-542-3838
  • Fax: 949-542-3839
Mailing address:
  • Phone: 949-542-3838
  • Fax: 949-542-3839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberA64090
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberA64090
License Number StateCA

VIII. Authorized Official

Name: DR. MARCELA I DOMINGUEZ
Title or Position: OWNER
Credential: M.D,
Phone: 949-542-3838