Individual
ANDI MATY BOBELLAN DOMINGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11314 ALDERIDGE CT, SAN DIEGO, CA 92131-3724
(619) 300-5271
Mailing address
24095 FUSCHIA CT, MURRIETA, CA 92562-2135
(760) 546-8502
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F3352132
DRIVER LICESNE
CA
Enumeration date
06/11/2025
Last updated
06/11/2025
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