Individual provider Active NPI

Angelica Cristina Dominguez

  • Marriage & Family Therapist
  • San Diego, CA
National Provider Identifier
1407374614
Registry record updated Nov 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
130942 Issued in CA
Practice address
402 W Broadway Ste 400
San Diego, CA 92101-3554
Phone
(866) 478-3978
Fax
(866) 473-0365
NPI assigned
Sep 7, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 130942 CA Primary

Addresses

Primary practice location

402 W Broadway Ste 400
San Diego, CA 92101-3554

Mailing address

4560 Hallmark Pkwy
P.O 9364
San Bernardino, CA 92407-1886
Phone (909) 266-2700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240709003749 CA Practitioner - Marriage and Family Therapist 4486199932 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
130942CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Cyti Health PC CurrentSince May 26, 2024 Accepting new patients

Locations

11801 Pierce St
Riverside, CA 92505
Phone (909) 528-0317

402 W Broadway
Ste 400
San Diego, CA 92101
Phone (619) 810-1939

3111 Camino del Rio N
Ste 460
San Diego, CA 92108

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1504742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761955200000",
    "number": "1407374614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4560 HALLMARK PKWY",
            "address_2": "P.O 9364",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924071886",
            "telephone_number": "909-266-2700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 W BROADWAY STE 400",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921013554",
            "telephone_number": "866-478-3978",
            "fax_number": "866-473-0365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINGUEZ",
        "first_name": "ANGELICA",
        "middle_name": "CRISTINA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-07",
        "last_updated": "2025-11-01",
        "certification_date": "2025-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "130942",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.