Provider Demographics
NPI:1154835353
Name:DOMINGO, ARTHUR BURGOS (PA-C)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:BURGOS
Last Name:DOMINGO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 SEASIDE AVE
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-2640
Mailing Address - Country:US
Mailing Address - Phone:808-426-8547
Mailing Address - Fax:
Practice Address - Street 1:445 SEASIDE AVE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-2640
Practice Address - Country:US
Practice Address - Phone:808-426-8547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAMD-793363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant