Provider Demographics
NPI:1629054168
Name:SZPYT-DOMANSKA, MARIA M (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:M
Last Name:SZPYT-DOMANSKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2719 N AIR FRESNO DR
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-1547
Mailing Address - Country:US
Mailing Address - Phone:559-600-8918
Mailing Address - Fax:559-600-7684
Practice Address - Street 1:2719 N AIR FRESNO DR
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1547
Practice Address - Country:US
Practice Address - Phone:559-600-8918
Practice Address - Fax:559-600-7684
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC538302084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209385301Medicaid
CAC53830OtherCALIFORNIA MEDICAL LICENSE #
CA1629054168OtherNPI
MO929211545Medicare ID - Type Unspecified