Individual
MRS. DIANNE DOMINGO-FORASTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2256 WHITTIER BLVD, LOS ANGELES, CA 90023-1243
(323) 268-8511
(323) 268-0717
Mailing address
2256 WHITTIER BLVD, LOS ANGELES, CA 90023-1243
(323) 268-8511
(323) 268-0717
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
G53343
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZZ70430Z
—
CA
Enumeration date
02/26/2007
Last updated
07/08/2007
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