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General NPI Number Information
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NPI Number | 1174764732
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Entity Type | Individual
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Provider Name | CECILIA M DOMINGUEZ PSY.D
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Gender | Female
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Dates
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Enumeration Date | 03/11/2009
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Last Update Date | 05/15/2019
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Provider Practice Location Address
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Address Line | 2101 NE 139TH ST STE 265
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City | VANCOUVER
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State | WA
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Zip | 98686-2311
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Country | US
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Telephone | 360-487-2700
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Fax | 360-487-2701
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Provider Business Mailing Address
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Address Line | 2209 E 2ND ST APT 6
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City | LOS ANGELES
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State | CA
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Zip | 90033-3960
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Country | US
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Telephone | 415-515-7364
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2673
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY60666459
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License Number State | WA
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