Provider Demographics
NPI:1376845057
Name:COMPLETE CARE FAMILY MEDICINE AND SKIN CENTER
Entity Type:Organization
Organization Name:COMPLETE CARE FAMILY MEDICINE AND SKIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARCELA
Authorized Official - Middle Name:ISABEL
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-542-3838
Mailing Address - Street 1:26800 CROWN VALLEY PKWY
Mailing Address - Street 2:STE 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:STE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64090261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care