Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003368341 |
---|---|
Provider Name | Roy A Dominguez JR. |
First Address | North Highlands, CA 95660 |
Second Address | North Highlands, CA 95660-5612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2016 |
Last Update Date | 03/11/2016 |