Provider Demographics
NPI:1003583618
Name:DOMINGUEZ, DEANZA (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:DEANZA
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 DE SOTO AVE APT A305
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-2647
Mailing Address - Country:US
Mailing Address - Phone:310-621-8529
Mailing Address - Fax:
Practice Address - Street 1:6221 WILSHIRE BLVD STE 518
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5223
Practice Address - Country:US
Practice Address - Phone:323-549-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist