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NPI Code Detail

MEDICARE: ANGELICA CRISTINA DOMINGUEZ

MEDICARE: ANGELICA CRISTINA DOMINGUEZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist130942CA

General Provider Information

NPI Number : 1407374614
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELICA CRISTINA DOMINGUEZ
Provider Business Mailing Address
First Line : 4560 HALLMARK PKWY
Second Line : P.O 9364
City : SAN BERNARDINO
State : CA
Zip : 92407-1886
Country : US
Telephone Number : 909-266-2700
Fax Number :
Provider Business Practice Location Address
First Line : 402 W BROADWAY STE 400
Second Line :
City : SAN DIEGO
State : CA
Zip : 92101-3554
Country : US
Telephone Number : 866-478-3978
Fax Number : 866-473-0365
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2017
Last Update Date : 11/01/2025

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Directions to “ ANGELICA CRISTINA DOMINGUEZ ” Practice Location

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