Provider Demographics
NPI:1801232079
Name:DOMINGUEZ, VERONICA SUSANA
Entity Type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:SUSANA
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 1:28446 YOSEMITE DR
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-1181
Mailing Address - Country:US
Mailing Address - Phone:714-858-1667
Mailing Address - Fax:
Practice Address - Street 1:29222 RANCHO VIEJO RD
Practice Address - Street 2:STE. 122
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1041
Practice Address - Country:US
Practice Address - Phone:949-429-6888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health