Healthcare Provider Details

I. General information

NPI: 1326942590
Provider Name (Legal Business Name): EDITHA VILLAMAR DOMINGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7057 HOWDERSHELL RD
HAZELWOOD MO
63042-3806
US

IV. Provider business mailing address

7057 HOWDERSHELL RD
HAZELWOOD MO
63042-3806
US

V. Phone/Fax

Practice location:
  • Phone: 808-729-8440
  • Fax:
Mailing address:
  • Phone: 808-729-8440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number731
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: