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General NPI Number Information
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NPI Number | 1942881206
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Entity Type | Individual
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Provider Name | MS. ANGELICA DOMINGUEZ
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Gender | Female
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Dates
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Enumeration Date | 04/19/2021
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 202 N 8TH ST
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City | EL CENTRO
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State | CA
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Zip | 92243-2302
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Country | US
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Telephone | 442-265-1525
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Fax |
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Provider Business Mailing Address
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Address Line | 1064 GRANT ST
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City | CALEXICO
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State | CA
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Zip | 92231-3602
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Country | US
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Telephone | 626-807-0142
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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 | 147599
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License Number State | CA
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