Active NPI
Dominique Santos
- Marriage & Family Therapist
- San Diego, CA
National Provider Identifier
1558905455
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 115525
- Practice address
- 4025 Camino del Rio S Ste 300
San Diego, CA 92108-4108 - Phone
- (619) 542-7720
- NPI assigned
- Nov 4, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 115525 | CA | Primary |
Addresses
Primary practice location
4025 Camino del Rio S Ste 300
San Diego, CA 92108-4108
Mailing address
PO Box 881513
San Diego, CA 92168-1513
Phone (619) 370-4969
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | dominique@stephenstherapy.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 115525 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1572825600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1572825600000",
"number": "1558905455",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 881513",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921681513",
"telephone_number": "619-370-4969"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4025 CAMINO DEL RIO S STE 300",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921084108",
"telephone_number": "619-542-7720"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANTOS",
"first_name": "DOMINIQUE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-11-04",
"last_updated": "2019-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "115525",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "dominique@stephenstherapy.com",
"affiliation": "N",
"address_1": "4025 Camino Del Rio S Ste 300",
"city": "San Diego",
"state": "CA",
"country_code": "US",
"postal_code": "921084108",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.