Provider Demographics
NPI:1063978542
Name:RINALDI, DOMENICO (OD)
Entity type:Individual
Prefix:DR
First Name:DOMENICO
Middle Name:
Last Name:RINALDI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4266 LINCOLN BLVD
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5618
Mailing Address - Country:US
Mailing Address - Phone:310-823-4595
Mailing Address - Fax:310-823-4598
Practice Address - Street 1:4266 LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5618
Practice Address - Country:US
Practice Address - Phone:310-823-4595
Practice Address - Fax:310-823-4598
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34194TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist