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General NPI Number Information
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NPI Number | 1831579267
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Entity Type | Individual
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Provider Name | DEBBIE ANN DOMINQUEZ-WIGGINS BSC.
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Gender | Female
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Dates
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Enumeration Date | 06/01/2015
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Last Update Date | 07/13/2023
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Provider Practice Location Address
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Address Line | 1296 LOHRMAN LN
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City | PETALUMA
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State | CA
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Zip | 94952-1650
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Country | US
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Telephone | 707-290-1899
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Fax | 707-776-4794
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Provider Business Mailing Address
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Address Line | 1296 LOHRMAN LN
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City | PETALUMA
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State | CA
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Zip | 94952-1650
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Country | US
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Telephone | 707-290-1899
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Fax | 707-776-4794
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | MPSS-YDOLQH
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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