Individual
DOMINGUE EMMANOUEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
1410 BONITA AVE, BERKELEY, CA 94709-1909
(510) 418-0233
Mailing address
1410 BONITA AVE, BERKELEY, CA 94709-1909
(510) 418-0233
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
738912
CA
Other
Enumeration date
06/03/2024
Last updated
06/03/2024
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