Organization
ACTIVE HEALTHCARE MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MIGUEL DOMINGO MD (MEDICAL DIRECTOR)
(626) 337-2888
Entity
Organization
Contact information
Practice address
512 S GLENDORA AVE, WEST COVINA, CA 91790-3022
(626) 337-2888
Mailing address
512 S GLENDORA AVE, WEST COVINA, CA 91790-3022
(626) 337-2888
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
225100000X
Physical Therapist
—
—
Other
Enumeration date
11/08/2007
Last updated
03/11/2009
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