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General NPI Number Information
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NPI Number | 1649482589
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Entity Type | Individual
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Provider Name | ADA FAJARDO DOMINGUEZ PT
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Gender | Female
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1200 N STATE ST
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City | LOS ANGELES
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State | CA
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Zip | 90033
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Country | US
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Telephone | 323-226-3765
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Fax | 323-226-2688
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Provider Business Mailing Address
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Address Line | 15510 ROJAS ST
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City | HACIENDA HEIGHTS
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State | CA
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Zip | 91745
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Country | US
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Telephone | 626-330-1677
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 12757
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License Number State | CA
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