| NPI | 1194150813 |
|---|---|
| Doing Business As | OC DOMER MEDICAL GROUP |
| Entity Type | Organization |
| Authorized Contact | TODD C MILLER President 909-215-9463 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: CO A90116) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: CA A90116) |
| Enumeration Date | 2013-09-12 |
| Last Update Date | 2013-09-12 |