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General NPI Number Information
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NPI Number | 1386118404
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Entity Type | Organization
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Legal Business Name | SHIRLEY DOMINGO, M.D., INC.
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Dates
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Enumeration Date | 01/11/2019
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Last Update Date | 02/11/2019
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Provider Practice Location Address
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Address Line | 3939 J ST STE 305
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City | SACRAMENTO
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State | CA
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Zip | 95819-3639
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Country | US
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Telephone | 310-613-0275
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Fax | 916-672-0290
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Provider Business Mailing Address
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Address Line | 6205 GUS WAY
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City | ELK GROVE
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State | CA
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Zip | 95757-5987
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | SHIRLEY ROSE RAMISCAL DOMINGO
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Credential | MD
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Telephone | 310-613-0275
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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