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General NPI Number Information
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NPI Number | 1558603381
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Entity Type | Organization
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Legal Business Name | EDWARD J. DOMANSKIS,MD INC.
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Dates
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Enumeration Date | 03/19/2013
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Last Update Date | 03/19/2013
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Provider Practice Location Address
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Address Line | 1441 AVOCADO AVE SUITE 307
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-7721
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Country | US
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Telephone | 949-640-9324
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Fax |
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Provider Business Mailing Address
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Address Line | 175 N REDWOOD DR SUITE 275
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City | SAN RAFAEL
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State | CA
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Zip | 94903-1972
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Country | US
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Telephone | 415-331-8390
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Fax |
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Authorized Official
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Title or Position | MD
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Name | DR. EDWARD DOMANSKIS
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Credential | MD
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Telephone | 415-331-8390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | G22703
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License Number State | CA
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