| M.l.domaguing,jr.m.d. | |
|
648 Rancho Los Nogales Dr Covina CA 91724-3351 | |
| (626) 862-3584 | |
| (626) 331-1839 |
| Full Name | M.l.domaguing,jr.m.d. |
|---|---|
| Speciality | Family Medicine |
| Location | 648 Rancho Los Nogales Dr, Covina, California |
| Authorized Official Name and Position | Macario L Domaguing Jr. (MD OWNER) |
| Authorized Official Contact | 6263354129 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| M.l.domaguing,jr.m.d. 648 Rancho Los Nogales Dr Covina CA 91724-3351 Ph: (626) 862-3584 | M.l.domaguing,jr.m.d. 648 Rancho Los Nogales Dr Covina CA 91724-3351 Ph: (626) 862-3584 |
| NPI Number | 1336255694 |
|---|---|
| Provider Enumeration Date | 08/21/2006 |
| Last Update Date | 02/27/2015 |
| Medicare PECOS PAC ID | 9234208745 |
|---|---|
| Medicare Enrollment ID | O20080522000551 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336255694 | NPI | - | NPPES |
| W22352 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A37893 (California) | Primary |
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