Provider Demographics
NPI:1013006683
Name:ENGEL, DOMINIQUE G (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMINIQUE
Middle Name:G
Last Name:ENGEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2767 OLIVE HWY
Mailing Address - Street 2:SUITE 16
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-6118
Mailing Address - Country:US
Mailing Address - Phone:530-533-3196
Mailing Address - Fax:530-533-3370
Practice Address - Street 1:2767 OLIVE HWY
Practice Address - Street 2:SUITE 16
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-6118
Practice Address - Country:US
Practice Address - Phone:530-533-3196
Practice Address - Fax:530-533-3370
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76800174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000G76800Medicaid
CAG76800OtherLICIENCE
CA000G76801Medicaid
CAG76800OtherLICIENCE
CA00G76801Medicare ID - Type UnspecifiedOROVILLE, CA NUMBER
CA000G76801Medicaid