Healthcare Provider Details

I. General information

NPI: 1184129827
Provider Name (Legal Business Name): DOMINIQUE DOMINGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1649 UKIAH WAY
SALINAS CA
93906-2137
US

IV. Provider business mailing address

PO BOX 10462
SALINAS CA
93912-7462
US

V. Phone/Fax

Practice location:
  • Phone: 831-206-0423
  • Fax:
Mailing address:
  • Phone: 831-206-0423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: