Provider Demographics
NPI:1043637317
Name:CATAPANG, DOMINGA
Entity Type:Individual
Prefix:
First Name:DOMINGA
Middle Name:
Last Name:CATAPANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8371 WOODLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91304-3138
Mailing Address - Country:US
Mailing Address - Phone:818-712-9384
Mailing Address - Fax:
Practice Address - Street 1:23664 COMMUNITY ST
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91304-3001
Practice Address - Country:US
Practice Address - Phone:818-710-9959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA191221801311ZA0620X
CA191221549311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home