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General NPI Number Information
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NPI Number | 1811701923
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Entity Type | Individual
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Provider Name | CHRISTOPHER JAMES DOMINGUEZ PA
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Gender | Male
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Dates
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Enumeration Date | 02/07/2025
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 5725 SOTO ST
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-2630
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Country | US
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Telephone | 805-222-5803
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Fax |
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Provider Business Mailing Address
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Address Line | 14621 TERRYKNOLL DR
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City | WHITTIER
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State | CA
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Zip | 90604-1307
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Country | US
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Telephone | 323-706-3819
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 65873
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License Number State | CA
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