Provider Demographics
NPI:1427568609
Name:DOMINGO, ADEL RUMBAWA
Entity Type:Individual
Prefix:
First Name:ADEL
Middle Name:RUMBAWA
Last Name:DOMINGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6184
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93539-6184
Mailing Address - Country:US
Mailing Address - Phone:661-917-0052
Mailing Address - Fax:
Practice Address - Street 1:1600 E AVENUE R4
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-6182
Practice Address - Country:US
Practice Address - Phone:661-917-0052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker