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General NPI Number Information
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NPI Number | 1487902433
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Entity Type | Individual
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Provider Name | JOEL DOMINGUEZ M.A., MFT
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Gender | Male
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Dates
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Enumeration Date | 08/23/2012
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Last Update Date | 11/23/2016
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Provider Practice Location Address
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Address Line | 4050 KATELLA AVE SUITE 102
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-3434
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Country | US
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Telephone | 562-260-9058
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Fax |
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Provider Business Mailing Address
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Address Line | 1604 CRESCENT HEIGHTS ST
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City | SIGNAL HILL
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State | CA
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Zip | 90755-3602
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Country | US
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Telephone | 562-260-9058
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC52052
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License Number State | CA
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