Provider Demographics
NPI:1760539464
Name:DOMALANTA-VILLALUNA, DINA D (MD)
Entity Type:Individual
Prefix:DR
First Name:DINA
Middle Name:D
Last Name:DOMALANTA-VILLALUNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DINA
Other - Middle Name:D
Other - Last Name:DOMALANTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:415 CHALAN SAN ANTONIO STE 109
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3620
Mailing Address - Country:US
Mailing Address - Phone:671-647-7337
Mailing Address - Fax:671-647-7336
Practice Address - Street 1:415 CHALAN SAN ANTONIO STE 109
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3620
Practice Address - Country:US
Practice Address - Phone:671-647-7337
Practice Address - Fax:671-647-7336
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM001402208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
56685OtherPIN
56685OtherPIN