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1700500600
DOMINADOR PERALTA MANSAT
ONTARIO, CA
NPI
1700500600
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: CA 95022872)
Enumeration Date
2022-10-04
Last Update Date
2022-10-04
Business Address
DOMINADOR PERALTA MANSAT FNP-C
1910 S ARCHIBALD AVE STE D
ONTARIO, CA 91761-8503
Phone number: 909-348-2556
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Mailing Address
DOMINADOR PERALTA MANSAT FNP-C
9415 RETREAT PL
RANCHO CUCAMONGA, CA 91730-9200
Phone number: 909-348-3067
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