Provider Demographics
NPI:1447465927
Name:DOMINGUEZ, ASCELA REGALA (DISPENSING OPTICIAN)
Entity type:Individual
Prefix:MRS
First Name:ASCELA
Middle Name:REGALA
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:DISPENSING OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:115 BREEZEWALK DR
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-7143
Mailing Address - Country:US
Mailing Address - Phone:707-557-5481
Mailing Address - Fax:707-648-3990
Practice Address - Street 1:115 BREEZEWALK DR
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-7143
Practice Address - Country:US
Practice Address - Phone:707-557-5481
Practice Address - Fax:707-648-3990
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34998156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician