Individual
MICHELLE MAE DOMINGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4075 TWEEDY BLVD, SOUTH GATE, CA 90280-6146
(323) 566-4111
Mailing address
4075 TWEEDY BLVD, SOUTH GATE, CA 90280-6146
(323) 566-4111
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
52600
CA
Other
Enumeration date
09/27/2010
Last updated
06/23/2015
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