Individual
MISS ELIS DOMINGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
260 E 15TH ST, MERCED, CA 95341-6216
(209) 381-1038
(209) 381-1056
Mailing address
260 E 15TH ST, MERCED, CA 95341-6216
(209) 381-1038
(209) 381-1056
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
VN 232412
CA
Other
Enumeration date
07/13/2010
Last updated
07/13/2010
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