Provider Demographics
NPI:1275601478
Name:DOMINGUEZ, GILBERT RYAN (MD)
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:RYAN
Last Name:DOMINGUEZ
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9850 GENESEE AVE
Mailing Address - Street 2:SUITE 810
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1224
Mailing Address - Country:US
Mailing Address - Phone:858-450-1212
Mailing Address - Fax:858-453-9271
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:SUITE 810
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1224
Practice Address - Country:US
Practice Address - Phone:858-450-1212
Practice Address - Fax:858-453-9271
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2023-03-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA75306207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine