Healthcare Provider Details

I. General information

NPI: 1043718141
Provider Name (Legal Business Name): MRS. RITA VIEIRA DOMINGOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1663 MISSION ST STE 460
SAN FRANCISCO CA
94103-2486
US

IV. Provider business mailing address

368 FELL ST
SAN FRANCISCO CA
94102-5144
US

V. Phone/Fax

Practice location:
  • Phone: 628-290-2028
  • Fax:
Mailing address:
  • Phone: 415-861-0828
  • Fax: 415-861-0257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number17505
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number148990
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: