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Individual
TINA L. R. DOMINGUEZ
Active
Individual
TINA L. R. DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, MMS
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
PA21463
CA
363A00000X
Physician Assistant
Primary
PA21463
CA
Other
Enumeration date
02/15/2011
Last updated
03/06/2020
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