Provider Demographics
NPI:1013466101
Name:A-1 DOMESTIC PROFESSIONAL SERVICES
Entity type:Organization
Organization Name:A-1 DOMESTIC PROFESSIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZETTE
Authorized Official - Middle Name:DOMINGUEZ
Authorized Official - Last Name:DAGDAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-929-8400
Mailing Address - Street 1:12631 IMPERIAL HWY
Mailing Address - Street 2:SUITE F-104
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-4710
Mailing Address - Country:US
Mailing Address - Phone:562-929-8400
Mailing Address - Fax:888-813-3646
Practice Address - Street 1:12631 IMPERIAL HWY
Practice Address - Street 2:SUITE F-104
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-4710
Practice Address - Country:US
Practice Address - Phone:562-929-8400
Practice Address - Fax:888-813-3646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0408-12631F104A253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care