Provider Demographics
NPI:1518977560
Name:LAO-DOMINGO, FELICIDAD G (MD)
Entity Type:Individual
Prefix:DR
First Name:FELICIDAD
Middle Name:G
Last Name:LAO-DOMINGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W 6TH ST
Mailing Address - Street 2:STE 1
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020
Mailing Address - Country:US
Mailing Address - Phone:408-847-1166
Mailing Address - Fax:408-847-3045
Practice Address - Street 1:700 W 6TH ST
Practice Address - Street 2:SUITE I
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020
Practice Address - Country:US
Practice Address - Phone:408-847-1166
Practice Address - Fax:408-847-3045
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33817207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A27263Medicare UPIN
00A338170Medicare ID - Type Unspecified