Provider Information for 1194025155
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DOMINIQUE MARIA OPUTA MA
Sex: Female
NPI: 1194025155
Last Updated: 2014-04-29
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1194025155 | ||||||||
| Enumeration Date | 2010-10-25 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 3941 PALMER CT COLLEGEVILLE, PA 19426-4810 United States Phone: 313-673-0763 | Fax: | ||||||||
| Primary Practice Address | 500 N WEST ST DOYLESTOWN, PA 18901-2366 United States Phone: 215-345-5300 | Fax: | ||||||||
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