Jennifer Dominguez

Key facts

NPI

1972931335

Entity type

Individual (NPI type 1)

Primary specialty

Clinical Social Worker 1041C0700X

License

21676 (CA)

Practice address

100 Prison Rd
Represa, CA 95671-0066

Phone

(916) 985-8610

Fax

(916) 294-3121

NPI assigned

Oct 23, 2013

Sex

Female

Sole proprietor

Yes

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.

• Corrections and Rehabilitation-Headquarters Pharmacy · Represa, CA · NPI 1154953529
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 7, 2022.

{
    "created_epoch": "1382486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662508800000",
    "number": "1972931335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 290066",
            "city": "REPRESA",
            "state": "CA",
            "postal_code": "956710066",
            "telephone_number": "916-985-8610",
            "fax_number": "916-294-3121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 PRISON RD",
            "city": "REPRESA",
            "state": "CA",
            "postal_code": "956710066",
            "telephone_number": "916-985-8610",
            "fax_number": "916-294-3121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINGUEZ",
        "first_name": "JENNIFER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-10-23",
        "last_updated": "2022-09-07",
        "certification_date": "2022-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "21676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Represa, CA

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• Lynne Demartini, PH.D.
• Harry Moran Singh Dhesi, DDS
• Melinda Susan Diciro, PSY.D.
• Grace Louise Downing, M.D.
• John Phillip Dunlap Jr., D.O.
• Shannon Taylor Egan-Mooney, PSYD
• Marsha Evans
• Dennis Rulon Fairbourn, DMD

All providers in Represa, CA · Clinical Social Worker in California