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NPI Code Detail

MEDICARE: MR. ALEJANDRO DOMINGO SMALL OTRL

MEDICARE: MR. ALEJANDRO DOMINGO SMALL OTRL
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
1225X00000XOccupational Therapist05746MD
2225X00000XOccupational TherapistOT010000400DC
3225X00000XOccupational TherapistOT4122CA
4225X00000XOccupational Therapist0119004495VA

General Provider Information

NPI Number : 1649394099
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ALEJANDRO DOMINGO SMALL OTRL
Provider Business Mailing Address
First Line : 1743 HAMPTON CT
Second Line :
City : BONITA
State : CA
Zip : 91902-4011
Country : US
Telephone Number : 909-374-0001
Fax Number :
Provider Business Practice Location Address
First Line : 6200 OREGON AVE NW
Second Line :
City : WASHINGTON
State : DC
Zip : 20015-1543
Country : US
Telephone Number : 202-541-0403
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2007
Last Update Date : 07/08/2007

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