Individual
MS. ADA FAJARDO DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1200 N STATE ST, LOS ANGELES, CA 90033
(323) 226-3765
(323) 226-2688
Mailing address
15510 ROJAS ST, HACIENDA HEIGHTS, CA 91745
(626) 330-1677
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
12757
CA
Other
Enumeration date
05/04/2007
Last updated
07/08/2007
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