Provider Demographics
NPI:1225039050
Name:DOMINGUEZ, MARCELA I (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCELA
Middle Name:I
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:26800 CROWN VALLEY PKWY
Mailing Address - Street 2:SUITE 435
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6384
Mailing Address - Country:US
Mailing Address - Phone:949-542-3838
Mailing Address - Fax:949-542-3839
Practice Address - Street 1:26800 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE 435
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6384
Practice Address - Country:US
Practice Address - Phone:949-542-3838
Practice Address - Fax:949-542-3839
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2010-01-08
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Provider Licenses
StateLicense IDTaxonomies
CAA64090207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH21410Medicare UPIN