| Domingo Therapy A Marriage And Family Therapy Professional Corporation | |
|
4127 Santa Rosa Ave Sacramento CA 95817-3442 | |
| (916) 234-3139 | |
| Not Available |
| Full Name | Domingo Therapy A Marriage And Family Therapy Professional Corporation |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 4127 Santa Rosa Ave, Sacramento, California |
| Authorized Official Name and Position | Jennifer Domingo (CEO) |
| Authorized Official Contact | 9165130466 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Domingo Therapy A Marriage And Family Therapy Professional Corporation 5716 Folsom Blvd # 348 Sacramento CA 95819-4608 Ph: (916) 234-3139 | Domingo Therapy A Marriage And Family Therapy Professional Corporation 4127 Santa Rosa Ave Sacramento CA 95817-3442 Ph: (916) 234-3139 |
| NPI Number | 1114783743 |
|---|---|
| Provider Enumeration Date | 02/21/2024 |
| Last Update Date | 02/21/2024 |
| Certification Date | 02/21/2024 |
| Medicare PECOS PAC ID | 6901347277 |
|---|---|
| Medicare Enrollment ID | O20240926002087 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114783743 | NPI | - | NPPES |
| Provider Name | Jennifer Ibanez Domingo |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1104097286 PECOS PAC ID: 0446791719 Enrollment ID: I20240926002193 |
| Provider Name | Karina Elena Bavery |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1477891679 PECOS PAC ID: 0345772380 Enrollment ID: I20241016001152 |
| Provider Name | Jon Christopher Gutoman |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1578814042 PECOS PAC ID: 7214469154 Enrollment ID: I20241016001786 |
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