Healthcare Provider Details

I. General information

NPI: 1902519952
Provider Name (Legal Business Name): JILLIAN APRIL NAPEEK DOMOGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2023
Last Update Date: 07/27/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 GEORGIA ST
VALLEJO CA
94590-6005
US

IV. Provider business mailing address

444 GEORGIA ST
VALLEJO CA
94590-6005
US

V. Phone/Fax

Practice location:
  • Phone: 707-703-5132
  • Fax:
Mailing address:
  • Phone: 707-703-5132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: