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General NPI Number Information
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NPI Number | 1629613435
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Entity Type | Individual
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Provider Name | MEGAN ROSE DOMINGUEZ OTR/L
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Gender | Female
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Dates
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Enumeration Date | 11/15/2019
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 3025 PYRITES ST
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City | LOS ANGELES
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State | CA
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Zip | 90032-2627
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Country | US
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Telephone | 310-569-8183
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Fax |
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Provider Business Mailing Address
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Address Line | 5314 N FIGUEROA ST UNIT B
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City | LOS ANGELES
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State | CA
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Zip | 90042-4004
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Country | US
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Telephone | 323-736-1893
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 18009
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License Number State | CA
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