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NPI Code Detail

MEDICARE: DR. DANIELA DOMINGUEZ PSYD

MEDICARE: DR. DANIELA DOMINGUEZ PSYD
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
1103TC1900XCounseling Psychologist29367CA

General Provider Information

NPI Number : 1720705460
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DANIELA DOMINGUEZ PSYD
Provider Business Mailing Address
First Line : 132 MARINERO CIR
Second Line :
City : BELVEDERE TIBURON
State : CA
Zip : 94920-1627
Country : US
Telephone Number : 415-212-9064
Fax Number :
Provider Business Practice Location Address
First Line : 245 KENTUCKY ST STE E
Second Line :
City : PETALUMA
State : CA
Zip : 94952-2877
Country : US
Telephone Number : 415-212-9064
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2022
Last Update Date : 10/03/2024

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