Provider Demographics
NPI:1003098757
Name:BERMOY, DOMINGA LIM RARUGAL (DMD)
Entity Type:Individual
Prefix:DR
First Name:DOMINGA
Middle Name:LIM RARUGAL
Last Name:BERMOY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 MARINE AVE
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-1528
Mailing Address - Country:US
Mailing Address - Phone:310-748-1527
Mailing Address - Fax:
Practice Address - Street 1:4310 MARINE AVE
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-1528
Practice Address - Country:US
Practice Address - Phone:310-748-1527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA382571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice