Healthcare Provider Details

I. General information

NPI: 1235980541
Provider Name (Legal Business Name): DOMINIKA USCINSKA CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2024
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 CAMINO DIABLO STE 305
WALNUT CREEK CA
94597-3962
US

IV. Provider business mailing address

2848 MONTANA ST
OAKLAND CA
94602-3237
US

V. Phone/Fax

Practice location:
  • Phone: 925-488-3151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number95315
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: