Healthcare Provider Details

I. General information

NPI: 1124337845
Provider Name (Legal Business Name): VERONICA MARIE DOMINGUEZ M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 NORMAL ST
SAN DIEGO CA
92103-2653
US

IV. Provider business mailing address

10923 CLAIREMONT MESA BLVD
SAN DIEGO CA
92124-1428
US

V. Phone/Fax

Practice location:
  • Phone: 619-725-5501
  • Fax:
Mailing address:
  • Phone: 619-559-9337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number15699
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: