Provider Demographics
NPI:1235693409
Name:DOMINGUEZ, ANGELA MARGARITA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARGARITA
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANEGLA
Other - Middle Name:MARGARITA
Other - Last Name:MANDUJANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RADT-I
Mailing Address - Street 1:2600 REDONDO AVE FL 6
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2325
Mailing Address - Country:US
Mailing Address - Phone:562-025-6029
Mailing Address - Fax:
Practice Address - Street 1:2600 REDONDO AVE FL 6
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2325
Practice Address - Country:US
Practice Address - Phone:562-256-2906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty