Individual
ANTONIO DOMINOVIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.T.(R)(CT)(ARRT)
Contact information
Practice address
17744 NE SAN RAFAEL ST, PORTLAND, OR 97230-5927
(800) 638-3240
Mailing address
3414 SE 144TH AVE, PORTLAND, OR 97236-2709
(503) 515-4985
Taxonomy
Speciality
Code
Description
License number
State
247100000X
Radiologic Technologist
60899550
WA
2471C3402X
Radiography Radiologic Technologist
Primary
917283
OR
Other
Enumeration date
06/28/2022
Last updated
06/28/2022
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