Healthcare Provider Details

I. General information

NPI: 1568847937
Provider Name (Legal Business Name): MARIA DOMINGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2015
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1965 LIVE OAK BLVD
YUBA CITY CA
95991-8850
US

IV. Provider business mailing address

1965 LIVE OAK BLVD
YUBA CITY CA
95991-8850
US

V. Phone/Fax

Practice location:
  • Phone: 530-822-7200
  • Fax:
Mailing address:
  • Phone: 530-822-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number64725
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number99904
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: