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General NPI Number Information
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NPI Number | 1316473135
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Entity Type | Individual
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Provider Name | DOMINIQUE DEBOLD PHARMD
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Gender | Female
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 6247 GRAHAM HILL RD
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City | FELTON
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State | CA
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Zip | 95018-9723
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Country | US
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Telephone | 831-335-6403
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Fax |
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Provider Business Mailing Address
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Address Line | 680 COLLEEN DR
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City | SAN JOSE
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State | CA
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Zip | 95123-5512
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Country | US
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Telephone | 415-894-0128
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 76191
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License Number State | CA
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