Provider Demographics
NPI:1396000444
Name:DOMINGUEZ, JULIETA CHRISTIAN
Entity Type:Individual
Prefix:MISS
First Name:JULIETA
Middle Name:CHRISTIAN
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 1:1757 WALLER ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-2727
Mailing Address - Country:US
Mailing Address - Phone:415-668-0494
Mailing Address - Fax:415-386-0959
Practice Address - Street 1:672 S. LAFAYETTE PARK PLACE
Practice Address - Street 2:SUITE 6
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057
Practice Address - Country:US
Practice Address - Phone:213-381-3626
Practice Address - Fax:213-380-8923
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1396000444OtherNPI NUMBER