Provider Demographics
NPI:1902932890
Name:DOMINGUEZ, GERARDO ERNESTO
Entity Type:Individual
Prefix:MR
First Name:GERARDO
Middle Name:ERNESTO
Last Name:DOMINGUEZ
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 1:1441 S HOPE ST APT 103
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-2963
Mailing Address - Country:US
Mailing Address - Phone:310-279-0852
Mailing Address - Fax:
Practice Address - Street 1:370 CRENSHAW BLVD STE E100
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-1728
Practice Address - Country:US
Practice Address - Phone:310-279-0852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator