Provider Demographics
NPI:1588913875
Name:DOMINIKO, EMELE
Entity type:Individual
Prefix:
First Name:EMELE
Middle Name:
Last Name:DOMINIKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 MARIAN CT APT 2
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-4334
Mailing Address - Country:US
Mailing Address - Phone:415-785-8741
Mailing Address - Fax:415-524-4214
Practice Address - Street 1:21 MARIAN CT APT 2
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-4334
Practice Address - Country:US
Practice Address - Phone:415-785-8741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-03
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care