Provider Demographics
NPI:1740647916
Name:DOMINICIS, ZITA ALEJANDRA (DDS)
Entity type:Individual
Prefix:DR
First Name:ZITA
Middle Name:ALEJANDRA
Last Name:DOMINICIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8202 FLORENCE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-3937
Mailing Address - Country:US
Mailing Address - Phone:562-861-8807
Mailing Address - Fax:
Practice Address - Street 1:8202 FLORENCE AVE STE 101
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-3937
Practice Address - Country:US
Practice Address - Phone:562-861-8807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA653481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice