Individual
DOMINIQUE J MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1000 W CARSON ST, TORRANCE, CA 90502-2004
(424) 306-4040
Mailing address
3181 SW SAM JACKSON PARK ROAD, OHSU, PORTLAND, OR 97239
(503) 494-8211
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
107247
CA
Other
Enumeration date
04/24/2015
Last updated
07/26/2022
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