Healthcare Provider Details

I. General information

NPI: 1710924006
Provider Name (Legal Business Name): VICTOR GONZALEZ DOMINGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 12/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 E HARVARD BLVD SUITE C
SANTA PAULA CA
93060-3372
US

IV. Provider business mailing address

5855 OLIVAS PARK DR
VENTURA CA
93003-7672
US

V. Phone/Fax

Practice location:
  • Phone: 805-525-9595
  • Fax: 805-525-6667
Mailing address:
  • Phone: 805-667-2801
  • Fax: 805-667-2865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA55866
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: