Provider Demographics
NPI:1689204158
Name:ZATARAIN, DOMINIQUE ALEXANDREA (PHARMD)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:ALEXANDREA
Last Name:ZATARAIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14163 DAVENTRY ST
Mailing Address - Street 2:
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-4420
Mailing Address - Country:US
Mailing Address - Phone:818-472-1133
Mailing Address - Fax:
Practice Address - Street 1:14163 DAVENTRY ST
Practice Address - Street 2:
Practice Address - City:ARLETA
Practice Address - State:CA
Practice Address - Zip Code:91331-4420
Practice Address - Country:US
Practice Address - Phone:818-472-1133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA85249183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program