Individual
DOMINIQUE SISTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4955 VAN NUYS BLVD, SUITE 615, SHERMAN OAKS, CA 91403-1801
(818) 905-2222
Mailing address
24719 LONG VALLEY RD, HIDDEN HILLS, CA 91302-1261
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
52023
CA
Other
Enumeration date
10/08/2014
Last updated
10/08/2014
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