Provider Demographics
NPI:1699838375
Name:DOMINGUEZ, STEVEN (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4040
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-1040
Mailing Address - Country:US
Mailing Address - Phone:714-761-3901
Mailing Address - Fax:714-821-6392
Practice Address - Street 1:3101 W COAST HWY
Practice Address - Street 2:ST 300
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4001
Practice Address - Country:US
Practice Address - Phone:714-761-3901
Practice Address - Fax:714-821-6392
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48186207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E51168Medicare UPIN
A48186Medicare ID - Type Unspecified