Individual
IVAN DOMINGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
824 MOUNT RANIER WAY, EL DORADO HILLS, CA 95762-4449
(818) 519-3699
Mailing address
824 MOUNT RANIER WAY, EL DORADO HILLS, CA 95762-4449
(818) 519-3699
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
D5281191
CA
Other
Enumeration date
07/03/2024
Last updated
07/12/2024
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