Provider Demographics
NPI:1275698409
Name:DOMINGUEZ, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 E CARTWRIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93725-9385
Mailing Address - Country:US
Mailing Address - Phone:559-498-7100
Mailing Address - Fax:559-498-7111
Practice Address - Street 1:3103 E CARTWRIGHT AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93725
Practice Address - Country:US
Practice Address - Phone:559-498-7100
Practice Address - Fax:559-498-7111
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)