MEDICARE: DR. MA.ANGELA PEREZ DOMINGUEZ

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	1223G0001X	General Practice Dentistry	50902	CA

General Provider Information

NPI Number	:	1952511040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MA.ANGELA PEREZ DOMINGUEZ

Provider Business Mailing Address
First Line	:	5890 OLINDA RD
Second Line	:
City	:	EL SOBRANTE
State	:	CA
Zip	:	94803-3544
Country	:	US
Telephone Number	:	310-748-0419
Fax Number	:

Provider Business Practice Location Address
First Line	:	1808 SPRINGS RD
Second Line	:
City	:	VALLEJO
State	:	CA
Zip	:	94591-5518
Country	:	US
Telephone Number	:	707-647-1072
Fax Number	:

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	03/14/2012

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