Provider Demographics
NPI:1609617786
Name:DOMINGO, ABIGAIL ANN CONSTANTINO (NP)
Entity type:Individual
Prefix:MRS
First Name:ABIGAIL ANN
Middle Name:CONSTANTINO
Last Name:DOMINGO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3451 W CENTURY BLVD STE B1
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90303-1228
Mailing Address - Country:US
Mailing Address - Phone:310-677-9400
Mailing Address - Fax:
Practice Address - Street 1:3451 W CENTURY BLVD STE B1
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90303-1228
Practice Address - Country:US
Practice Address - Phone:310-677-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028754207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine