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General NPI Number Information
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NPI Number | 1356535843
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Entity Type | Individual
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Provider Name | DANIEL FONTANEZ DOMINGUEZ JR. MSW, LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/28/2007
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Last Update Date | 09/21/2007
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Provider Practice Location Address
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Address Line | 1075 E SANTA CLARA ST
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City | SAN JOSE
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State | CA
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Zip | 95116-2244
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Country | US
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Telephone | 408-299-6785
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Fax | 408-298-0192
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Provider Business Mailing Address
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Address Line | 884 MULCASTER CT
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City | SAN JOSE
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State | CA
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Zip | 95136-1758
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Country | US
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Telephone | 408-299-6785
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Fax | 408-298-0192
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LCS18257
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License Number State | CA
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