Provider Demographics
NPI:1215647789
Name:DOMINGO, ARVIN JOHN LIWAG
Entity type:Individual
Prefix:MR
First Name:ARVIN JOHN
Middle Name:LIWAG
Last Name:DOMINGO
Suffix:
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 1:14171 SPRUCE GROVE CT
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-9278
Mailing Address - Country:US
Mailing Address - Phone:909-576-9281
Mailing Address - Fax:
Practice Address - Street 1:14171 SPRUCE GROVE CT
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-9278
Practice Address - Country:US
Practice Address - Phone:909-576-9281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-25
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87139183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist