MEDICARE: MR. ALONSO JOSE DOMINGUEZ JR. 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
1	106H00000X	Marriage & Family Therapist	LMFT52832	CA

General Provider Information

NPI Number	:	1922813328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALONSO JOSE DOMINGUEZ JR. LMFT

Provider Business Mailing Address
First Line	:	PO BOX 1081
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90232-1081
Country	:	US
Telephone Number	:	424-777-5027
Fax Number	:

Provider Business Practice Location Address
First Line	:	9043 KRUEGER ST
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90232-2545
Country	:	US
Telephone Number	:	424-777-5027
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2025
Last Update Date	:	02/11/2025

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