Individual
CAL ANTHONY DOMINGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
A10610
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1624861
—
LA
01
—
P00220721
RR MEDICARE
LA
Enumeration date
12/09/2005
Last updated
12/31/2015
Update your record
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