Provider Demographics
NPI:1972692051
Name:DOMINGUEZ, ANDRES E (PHARM D)
Entity type:Individual
Prefix:
First Name:ANDRES
Middle Name:E
Last Name:DOMINGUEZ
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:ANDRES
Other - Middle Name:E
Other - Last Name:DOMINGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2055 N PERRIS BLVD
Mailing Address - Street 2:SUITE A1
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571
Mailing Address - Country:US
Mailing Address - Phone:951-943-8188
Mailing Address - Fax:951-943-8199
Practice Address - Street 1:2055 N PERRIS BLVD
Practice Address - Street 2:SUITE A1
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571
Practice Address - Country:US
Practice Address - Phone:951-943-8188
Practice Address - Fax:951-943-8199
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH36435183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH36435OtherCA STATE BOARD OF PHCY