Dominique Mall,md,inc

NPI 1053465062 - Internal Medicine - 207RN0300X

NPI Details
NPI 1053465062
Enumeration Date 01/23/2007
Last Updated 08/24/2011
Entity Type Healthcare Provider
Active Over 9 years ago
Authorized Information
Name DOMINIQUE LUCIENNE DOMINIQUE
Position PRESIDENT
Phone (310) 577-9547
Fax (310) 577-9547
Practice Location
13911 OLD HARBOR LN
#306
MARINA DEL REY CA, 90292-7395, US
Phone (310) 577-9547
Fax (310) 577-9547
Business Location
13911 OLD HARBOR LN
#306
MARINA DEL REY CA, 90292-7395, US
Phone (310) 577-9547
Fax (310) 577-9547
Toxanomy
Taxonomy Code 207RN0300X
License State
License Number
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According to our database, Dominique Mall,md,inc NPI is 1053465062, taxonomy code is 207RN0300X Dominique Mall,md,inc physically located at 13911 Old Harbor Ln, Marina Del Rey CA, 90292-7395. NPI Number 1033115704 has the healthcare provider type.

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1053465062 NPI number is provided on an as is basis without warranty of any kind. 1053465062 is maintained by the National Plan & Provider Enumeration System. The contents of Dominique Mall,md,inc are for informational purposes only.