Healthcare Provider Details

I. General information

NPI: 1598883845
Provider Name (Legal Business Name): DOMINIQUE EUGENE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 NATIVIDAD RD RM 200
SALINAS CA
93906
US

IV. Provider business mailing address

1000 S MAIN ST STE 105
SALINAS CA
93901-2394
US

V. Phone/Fax

Practice location:
  • Phone: 831-796-1500
  • Fax:
Mailing address:
  • Phone: 831-796-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 41467
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: