Healthcare Provider Details

I. General information

NPI: 1316603319
Provider Name (Legal Business Name): DOMINIC AIELLO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2021
Last Update Date: 10/22/2026
Certification Date: 11/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 GUERRERO ST STE A
SAN FRANCISCO CA
94110-1015
US

IV. Provider business mailing address

424 GUERRERO ST STE A
SAN FRANCISCO CA
94110-1015
US

V. Phone/Fax

Practice location:
  • Phone: 415-621-5661
  • Fax: 415-621-5466
Mailing address:
  • Phone: 415-621-5661
  • Fax: 415-621-5466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number23478
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number164919
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: