Basic Information
| Provider Information | |||||||||
| NPI: | 1477855583 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOMINGUEZ | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | NORET | ||||||||
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| OtherLastName: | DOMINUEZ | ||||||||
| OtherFirstName: | DANIELLE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 17701 SAN PASQUAL VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920255301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607414300 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 17701 SAN PASQUAL VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920255301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607414300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2010 | ||||||||
| LastUpdateDate: | 04/17/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 106H00000X | 68767 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.