Provider Demographics
NPI:1619924305
Name:CARIASO, DOMINADOR FREDERICK P JR (MD)
Entity Type:Individual
Prefix:
First Name:DOMINADOR FREDERICK
Middle Name:P
Last Name:CARIASO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19491 CHUPAROSA RD
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-1689
Mailing Address - Country:US
Mailing Address - Phone:502-533-7666
Mailing Address - Fax:
Practice Address - Street 1:19491 CHUPAROSA RD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1689
Practice Address - Country:US
Practice Address - Phone:502-533-7666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53511207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACR329YMedicare PIN