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NPI Code Detail

MEDICARE: MRS. JOANA PAVO DOMINGO LMFT

MEDICARE: MRS. JOANA PAVO DOMINGO LMFT
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 TherapistMFC 51074CA
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1730206285
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JOANA PAVO DOMINGO LMFT
Provider Business Mailing Address
First Line : 506 W JACKMAN ST
Second Line :
City : LANCASTER
State : CA
Zip : 93534-2531
Country : US
Telephone Number : 661-579-8330
Fax Number :
Provider Business Practice Location Address
First Line : 506 W JACKMAN ST
Second Line :
City : LANCASTER
State : CA
Zip : 93534-2531
Country : US
Telephone Number : 661-579-8330
Fax Number : 661-726-2854
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2007
Last Update Date : 12/09/2020

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