Healthcare Provider Details

I. General information

NPI: 1679437966
Provider Name (Legal Business Name): CLAIRE ELIZABETH DOMINION
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6950 ANALY AVE
SEBASTOPOL CA
95472-3492
US

IV. Provider business mailing address

327 JESSE ST
SEBASTOPOL CA
95472-3620
US

V. Phone/Fax

Practice location:
  • Phone: 707-824-2300
  • Fax: 707-634-7140
Mailing address:
  • Phone: 408-472-9981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: