Individual provider Active NPI

Ercilia Dominguez, MFT

  • Marriage & Family Therapist
  • Van Nuys, CA
National Provider Identifier
1558909267
Registry record updated Mar 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
AMFT153347 Issued in CA
Practice address
14545 Sherman Way Cir
Van Nuys, CA 91405
Phone
(818) 901-4830
NPI assigned
Dec 12, 2019
Last updated
Mar 7, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 206722 CA
Marriage & Family Therapist 106H00000X AMFT112092 CA
Marriage & Family Therapist 106H00000X AMFT153347 CA Primary
Rehabilitation Practitioner 225400000X AMFT112092 CA

Addresses

Primary practice location

14545 Sherman Way Cir
Van Nuys, CA 91405

Mailing address

14545 Sherman Way Cir
Van Nuys, CA 91405
Phone (818) 901-4930

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

LicenseStateTypeSpecialty
206722CAMDAddiction (Substance Use Disorder) Counselor
AMFT112092CAMDMarriage & Family Therapist
AMFT153347CAMDMarriage & Family Therapist

NPI Registry JSON

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

{
    "created_epoch": "1576108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741305600000",
    "number": "1558909267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14545 SHERMAN WAY CIR",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "91405",
            "telephone_number": "818-901-4930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14545 SHERMAN WAY CIR",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "91405",
            "telephone_number": "818-901-4830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINGUEZ",
        "first_name": "ERCILIA",
        "credential": "MFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-12",
        "last_updated": "2025-03-07",
        "certification_date": "2025-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "206722",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "AMFT112092",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "AMFT153347",
            "primary": true
        },
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": "CA",
            "license": "AMFT112092",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Van Nuys, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.