Provider Demographics
NPI:1710924006
Name:DOMINGUEZ, VICTOR GONZALEZ (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:GONZALEZ
Last Name:DOMINGUEZ
Suffix:
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 1:5855 OLIVAS PARK DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7672
Mailing Address - Country:US
Mailing Address - Phone:805-667-2801
Mailing Address - Fax:805-667-2865
Practice Address - Street 1:242 E HARVARD BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-3372
Practice Address - Country:US
Practice Address - Phone:805-525-9595
Practice Address - Fax:805-525-6667
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55866207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM18553HMedicaid
CA050394OtherBLUE CROSS
CA1215903018OtherNPI
CA951683892OtherOTHER INSURANCE
CAZZT40394FMedicaid
CARHM08608FMedicaid
CARHM08609FMedicaid
CAWA55866FMedicare ID - Type UnspecifiedPPIN
CAWA55866CMedicare ID - Type UnspecifiedPPIN
CA1215903018OtherNPI
CAWA55866DMedicare ID - Type UnspecifiedPPIN
CAZZT40394FMedicaid
CA951683892OtherOTHER INSURANCE
CA050394OtherBLUE CROSS
CAWA55866AMedicare ID - Type UnspecifiedPPIN
CA058608Medicare ID - Type UnspecifiedRH MEDICARE
CA050394Medicare ID - Type UnspecifiedMEDICARE
CAWA55866EMedicare ID - Type UnspecifiedPPIN