Provider Demographics
NPI:1851937551
Name:EMAGUNA, DOMIQUE BERNADETTE
Entity Type:Individual
Prefix:
First Name:DOMIQUE
Middle Name:BERNADETTE
Last Name:EMAGUNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CENTERPOINTE DR STE 130
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-2562
Mailing Address - Country:US
Mailing Address - Phone:657-325-8313
Mailing Address - Fax:
Practice Address - Street 1:20 CENTERPOINTE DR STE 130
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-2562
Practice Address - Country:US
Practice Address - Phone:657-325-8313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-18
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker