Provider Demographics
NPI:1497992531
Name:DOMINIQUE G, ENGEL, MD INC
Entity Type:Organization
Organization Name:DOMINIQUE G, ENGEL, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:G
Authorized Official - Last Name:ENGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-533-3196
Mailing Address - Street 1:2767 OLIVE HWY
Mailing Address - Street 2:SUITE 16
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-6118
Mailing Address - Country:US
Mailing Address - Phone:530-533-3196
Mailing Address - Fax:830-533-3370
Practice Address - Street 1:2767 OLIVE HWY
Practice Address - Street 2:SUITE 16
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-6118
Practice Address - Country:US
Practice Address - Phone:530-533-3196
Practice Address - Fax:830-533-3370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000G76800Medicaid
CA000G76801Medicaid
CA000G76801Medicaid