Provider Demographics
NPI:1003368341
Name:DOMINGUEZ, ROY A JR
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:A
Last Name:DOMINGUEZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 LONGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NORTH HIGHLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:95660
Mailing Address - Country:US
Mailing Address - Phone:916-346-0678
Mailing Address - Fax:
Practice Address - Street 1:4510 LONGVIEW DR
Practice Address - Street 2:
Practice Address - City:NORTH HIGHLANDS
Practice Address - State:CA
Practice Address - Zip Code:95660-5612
Practice Address - Country:US
Practice Address - Phone:916-346-0678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker