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General NPI Number Information
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NPI Number | 1255475356
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Entity Type | Organization
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Legal Business Name | DOMINGO C BARRIENTOS,MD
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 14044 VICTORY BLVD
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City | VAN NUYS
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State | CA
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Zip | 91401-2226
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Country | US
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Telephone | 818-376-0405
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Fax | 818-376-0461
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Provider Business Mailing Address
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Address Line | 17216 SATICOY ST PMB 347
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City | VAN NUYS
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State | CA
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Zip | 91406-2103
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Country | US
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Telephone | 818-376-0405
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Fax | 818-376-0461
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DOMINGO CHUA BARRIENTOS
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Credential | M.D.
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Telephone | 818-376-0405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A56239
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License Number State | CA
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