Provider Demographics
NPI:1992039143
Name:FITTIPALDI, DOMINICK
Entity Type:Individual
Prefix:
First Name:DOMINICK
Middle Name:
Last Name:FITTIPALDI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 OLYMPIC BLVD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5089
Mailing Address - Country:US
Mailing Address - Phone:925-933-2627
Mailing Address - Fax:925-933-5824
Practice Address - Street 1:1855 OLYMPIC BLVD
Practice Address - Street 2:SUITE 225
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5089
Practice Address - Country:US
Practice Address - Phone:925-933-2627
Practice Address - Fax:925-933-5824
Is Sole Proprietor?:No
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor