Provider Demographics
NPI:1962686469
Name:DOMINGO, SONAE P
Entity Type:Individual
Prefix:
First Name:SONAE
Middle Name:P
Last Name:DOMINGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SONAE
Other - Middle Name:P
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:320 W TEMPLE ST FL 9
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-3217
Mailing Address - Country:US
Mailing Address - Phone:213-974-9691
Mailing Address - Fax:213-620-1405
Practice Address - Street 1:320 W TEMPLE ST FL 9
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-3217
Practice Address - Country:US
Practice Address - Phone:213-974-9691
Practice Address - Fax:213-620-1405
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator