Provider Demographics
NPI:1528706207
Name:DOMINGO, RALPH SALIB-O (NP-C)
Entity type:Individual
Prefix:MR
First Name:RALPH
Middle Name:SALIB-O
Last Name:DOMINGO
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:MR
Other - First Name:RALPH
Other - Middle Name:SALIB-O
Other - Last Name:DOMINGO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RALPH DOMINGO NP-C
Mailing Address - Street 1:2180 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1625
Mailing Address - Country:US
Mailing Address - Phone:808-249-8080
Mailing Address - Fax:
Practice Address - Street 1:2180 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1625
Practice Address - Country:US
Practice Address - Phone:808-242-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-3670363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner