Active NPI
Maritza Dominguez
- Marriage & Family Therapist
- Upland, CA
National Provider Identifier
1679018808
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- Practice address
- 1425 W Foothill Blvd Ste 300
Upland, CA 91786-3689 - Phone
- (722) 787-7527
- NPI assigned
- Dec 26, 2016
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Marriage & Family Therapist | 106H00000X | Primary |
Addresses
Primary practice location
1425 W Foothill Blvd Ste 300
Upland, CA 91786-3689
Mailing address
1520 Teta Dr
Corona, CA 92882-4048
Phone (951) 454-4346
Other practice location 1
12966 Euclid St
#280
Garden Grove, CA 92840-5200
Phone (714) 823-4770
Other practice location 2
222 N Mountain Ave Ste 110B
Upland, CA 91786
Phone (909) 303-2505
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1482710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606953600000",
"number": "1679018808",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1520 TETA DR",
"city": "CORONA",
"state": "CA",
"postal_code": "928824048",
"telephone_number": "951-454-4346"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1425 W FOOTHILL BLVD STE 300",
"city": "UPLAND",
"state": "CA",
"postal_code": "917863689",
"telephone_number": "722-787-7527"
}
],
"practiceLocations": [
{
"address_1": "12966 Euclid St",
"address_2": "#280",
"address_purpose": "LOCATION",
"city": "Garden Grove",
"state": "CA",
"postal_code": "928405200",
"country_code": "US",
"telephone_number": "714-823-4770",
"fax_number": "714-823-4777",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "222 N Mountain Ave Ste 110B",
"address_purpose": "LOCATION",
"city": "Upland",
"state": "CA",
"postal_code": "91786",
"country_code": "US",
"telephone_number": "909-303-2505",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DOMINGUEZ",
"first_name": "MARITZA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-12-26",
"last_updated": "2020-12-03",
"certification_date": "2020-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Upland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.