Provider Demographics
NPI:1184984486
Name:DOMINGUEZ, ROBERT DAVID (PT ASST)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DAVID
Last Name:DOMINGUEZ
Suffix:
Gender:M
Credentials:PT ASST
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Mailing Address - Street 1:1725 STORRS PL
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-4130
Mailing Address - Country:US
Mailing Address - Phone:909-374-8897
Mailing Address - Fax:
Practice Address - Street 1:8655 HAVEN AVE
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4889
Practice Address - Country:US
Practice Address - Phone:800-642-5031
Practice Address - Fax:909-989-7633
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAT 2093225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant