Provider Demographics
NPI:1053488676
Name:SIGNORELLI, DOMENIC (DPM)
Entity type:Individual
Prefix:DR
First Name:DOMENIC
Middle Name:
Last Name:SIGNORELLI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7108 KATELLA AVE
Mailing Address - Street 2:400
Mailing Address - City:STANTON
Mailing Address - State:CA
Mailing Address - Zip Code:90680-2803
Mailing Address - Country:US
Mailing Address - Phone:714-543-3500
Mailing Address - Fax:866-379-7238
Practice Address - Street 1:1125 E 17TH ST
Practice Address - Street 2:SUITE E101
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2201
Practice Address - Country:US
Practice Address - Phone:714-543-3500
Practice Address - Fax:866-379-7438
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4065207X00000X
CAE 4065207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery