Provider Demographics
NPI:1891156295
Name:DOMINICCI RODRIGUEZ, ROBERTO (PPS)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:DOMINICCI RODRIGUEZ
Suffix:
Gender:M
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2275 SOUTH MAIN STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882
Mailing Address - Country:US
Mailing Address - Phone:951-279-3222
Mailing Address - Fax:951-279-5222
Practice Address - Street 1:12968 FREDERICK ST
Practice Address - Street 2:SUITE D
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-5229
Practice Address - Country:US
Practice Address - Phone:951-242-7738
Practice Address - Fax:951-252-7733
Is Sole Proprietor?:No
Enumeration Date:2016-03-11
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program