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General NPI Number Information
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NPI Number | 1205242153
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Entity Type | Organization
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Legal Business Name | SUSAN DOMINIC, MD., INC.
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Dates
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Enumeration Date | 07/10/2014
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Last Update Date | 07/10/2014
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Provider Practice Location Address
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Address Line | 7780 N FRESNO ST STE 100
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City | FRESNO
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State | CA
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Zip | 93720-2413
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Country | US
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Telephone | 559-493-5760
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Fax | 559-493-5292
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Provider Business Mailing Address
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Address Line | 7780 N FRESNO ST STE 100
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City | FRESNO
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State | CA
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Zip | 93720-2413
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Country | US
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Telephone | 559-493-5760
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Fax | 559-493-5292
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Authorized Official
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Title or Position | OWNER / CEO
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Name | DR. SUSAN DOMINIC
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Credential | M.D,
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Telephone | 559-493-5760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G68190
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License Number State | CA
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