MR. Michael William Dominisse JR., PA

NPI #1962914580 in Folsom, California

Provider Information

NPI Number: 1962914580
Entity Type: Individual
Name: MR. Michael William Dominisse JR., PA
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA
Enumeration Date: Nov 5, 2017
Last Updated: Nov 5, 2017

Practice Location

Address: 111 ALVASTON CT
City: Folsom
State: California
ZIP Code: 95630-8614
Phone: (916) 402-7388

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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