Individual
DIANA SANTO DOMINGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3883 AIRWAY DR STE 203, SANTA ROSA, CA 95403-1671
(707) 521-4495
(707) 573-5421
Mailing address
325 DISTEL CIR, LOS ALTOS, CA 94022-1408
(707) 521-4495
(707) 573-5421
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
997612
CA
207N00000X
Dermatology Physician
Primary
C168169
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C168169
STATE MEDICAL LICENSE
CA
Enumeration date
05/31/2007
Last updated
09/22/2023
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