Provider Demographics
NPI:1558566364
Name:COMPLETE CARE FAMILY MEDICINE
Entity Type:Organization
Organization Name:COMPLETE CARE FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCELA
Authorized Official - Middle Name:I
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 PARKWAY
Mailing Address - Street 2:SUITE 435
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691
Mailing Address - Country:US
Mailing Address - Phone:949-542-3838
Mailing Address - Fax:949-542-3839
Practice Address - Street 1:26800 CROWN VALLEY PARKWAY
Practice Address - Street 2:SUITE 435
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691
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:2007-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64090133NN1002X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty
Not Answered305S00000XManaged Care OrganizationsPoint of Service