Individual
MA PORTIA BERNADETTE GUCE DOMINGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
819 S 13TH ST, MOUNT VERNON, WA 98274-4112
(360) 814-6230
Mailing address
1400 E KINCAID ST, MOUNT VERNON, WA 98274-4127
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
OL61440780
WA
Other
Enumeration date
04/19/2023
Last updated
07/12/2023
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