Healthcare Provider Details

I. General information

NPI: 1013340827
Provider Name (Legal Business Name): DR. NADINE DOMUE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2013
Last Update Date: 05/02/2021
Certification Date: 05/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 CECIL AVE
DELANO CA
93215
US

IV. Provider business mailing address

7167 DANBURY AVE
HESPERIA CA
92345-8807
US

V. Phone/Fax

Practice location:
  • Phone: 661-721-2345
  • Fax:
Mailing address:
  • Phone: 909-633-2399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY28544
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: