Provider Demographics
NPI:1932550951
Name:DOMINGO, EMILIO JR
Entity Type:Individual
Prefix:MR
First Name:EMILIO
Middle Name:
Last Name:DOMINGO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:948 WINANT ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-4267
Mailing Address - Country:US
Mailing Address - Phone:808-954-2188
Mailing Address - Fax:
Practice Address - Street 1:948 WINANT ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-4267
Practice Address - Country:US
Practice Address - Phone:808-954-2188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI13190171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor