MEDICARE: EULA DOMINGUEZ PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	71034	CA

General Provider Information

NPI Number	:	1629478284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EULA DOMINGUEZ PHARMD

Provider Business Mailing Address
First Line	:	5395 NAPA ST APT 230
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-2650
Country	:	US
Telephone Number	:	626-898-3872
Fax Number	:

Provider Business Practice Location Address
First Line	:	2230 OTAY LAKES RD
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91915-1000
Country	:	US
Telephone Number	:	619-656-6944
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2014
Last Update Date	:	09/01/2014

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