Provider Demographics
NPI:1992797435
Name:SANTO DOMINGO, NOEL E (MD)
Entity type:Individual
Prefix:
First Name:NOEL
Middle Name:E
Last Name:SANTO DOMINGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3536 MENDOCINO AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-3634
Mailing Address - Country:US
Mailing Address - Phone:707-573-6166
Mailing Address - Fax:707-573-6165
Practice Address - Street 1:719 SOUTHPOINT BLVD
Practice Address - Street 2:STE B
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-1495
Practice Address - Country:US
Practice Address - Phone:707-778-8421
Practice Address - Fax:707-778-1702
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG79253207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01719259OtherRAILROAD MEDICARE
CAP00977322OtherRAILROAD MEDICARE
CACA208969Medicare PIN
CAFE314YMedicare PIN
F65004Medicare UPIN
CAFE314XMedicare PIN
CAP00977322OtherRAILROAD MEDICARE