Basic Information
| Provider Information | |||||||||
| NPI: | 1073605846 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADDONIZIO | ||||||||
| FirstName: | DOMINICK | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | I | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 653 N TOWN CENTER DR | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891440514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027967546 | ||||||||
| FaxNumber: | 7028696146 | ||||||||
| Practice Location | |||||||||
| Address1: | 653 N TOWN CENTER DR | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891440514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024507546 | ||||||||
| FaxNumber: | 7028696146 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 10/23/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207NS0135X | 9088 | NV | Y | Allopathic & Osteopathic Physicians | Dermatology | Procedural Dermatology |
No ID Information.