Provider Demographics
NPI:1184685281
Name:BARRIENTOS, DOMINGO CHUA (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMINGO
Middle Name:CHUA
Last Name:BARRIENTOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9800 PANGBORN AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-3534
Mailing Address - Country:US
Mailing Address - Phone:562-869-1322
Mailing Address - Fax:
Practice Address - Street 1:10800 PARAMOUNT BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-3331
Practice Address - Country:US
Practice Address - Phone:562-869-1322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56239207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A562390Medicaid
CA00A562390Medicaid
CAG39494Medicare UPIN