Provider Demographics
NPI:1518031376
Name:DOMINGUEZ-BARROS, INES N (PHD)
Entity Type:Individual
Prefix:
First Name:INES
Middle Name:N
Last Name:DOMINGUEZ-BARROS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2772 4TH AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-6206
Mailing Address - Country:US
Mailing Address - Phone:619-295-6067
Mailing Address - Fax:619-295-6047
Practice Address - Street 1:2772 4TH AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-6206
Practice Address - Country:US
Practice Address - Phone:619-295-6067
Practice Address - Fax:619-295-6047
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 26075103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical