Active NPI
Emil R Dominguez Jr., M.D
- Pediatrics Physician
- West Covina, CA
National Provider Identifier
1992867766
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- A43966
- Practice address
- 409 E Merced Ave
Suite #a
West Covina, CA 91790-5061 - Phone
- (626) 931-0901
- Fax
- (626) 931-0905
- NPI assigned
- Dec 15, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | A43966 | CA | Primary |
Addresses
Primary practice location
409 E Merced Ave
Suite #a
West Covina, CA 91790-5061
Mailing address
409 E Merced Ave
Suite #a
West Covina, CA 91790-5061
Phone (626) 931-0901
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A439660 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A43966 | CA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Emanate Health Medical Center | Past | Accepting new patients | |
| St. Joseph Health Northern California, LLC | Past | Accepting new patients | |
| Emanate Health Medical Center | Past | Accepting new patients | |
| Los Ninos Children Medical Clinic Inc. | Pediatrics | Past | Accepting new patients |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatrics Physician
- West Covina, CA
- NPI 1700115722
-
- General Acute Care Hospital
- West Covina, CA
- NPI 1063441293
-
- General Acute Care Hospital
- Covina, CA
- NPI 1982629440
-
- Rehabilitation Hospital Unit
- Napa, CA
- NPI 1609947282
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1992867766",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "409 E MERCED AVE",
"address_2": "SUITE #A",
"city": "WEST COVINA",
"state": "CA",
"postal_code": "917905061",
"telephone_number": "626-931-0901",
"fax_number": "626-931-0905"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "409 E MERCED AVE",
"address_2": "SUITE #A",
"city": "WEST COVINA",
"state": "CA",
"postal_code": "917905061",
"telephone_number": "626-931-0901",
"fax_number": "626-931-0905"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMINGUEZ",
"first_name": "EMIL",
"middle_name": "R",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "M.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-15",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "A43966",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A439660",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Covina, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.