Provider Demographics
NPI:1164992004
Name:DOMINO, SCOTT F (RCP)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:F
Last Name:DOMINO
Suffix:
Gender:M
Credentials:RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-3010
Mailing Address - Country:US
Mailing Address - Phone:415-272-6755
Mailing Address - Fax:415-833-4450
Practice Address - Street 1:450 6TH AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-3010
Practice Address - Country:US
Practice Address - Phone:415-272-6755
Practice Address - Fax:415-833-4450
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25128227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA25128OtherRESPIRATORY CARE PRACTIONER