Healthcare Provider Details

I. General information

NPI: 1215400619
Provider Name (Legal Business Name): LIZBETH DOMINGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21021 VENTURA BLVD
WOODLAND HILLS CA
91364-2206
US

IV. Provider business mailing address

21021 VENTURA BLVD
WOODLAND HILLS CA
91364-2206
US

V. Phone/Fax

Practice location:
  • Phone: 322-649-8919
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number23535
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: