Provider Demographics
NPI:1629478284
Name:DOMINGUEZ, EULA (PHARMD)
Entity Type:Individual
Prefix:
First Name:EULA
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:EULA NOELLE
Other - Middle Name:DAVID
Other - Last Name:DOMINGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:5395 NAPA ST APT 230
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-2650
Mailing Address - Country:US
Mailing Address - Phone:626-898-3872
Mailing Address - Fax:
Practice Address - Street 1:2230 OTAY LAKES RD
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915-1000
Practice Address - Country:US
Practice Address - Phone:619-656-6944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-01
Last Update Date:2014-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71034183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist