Individual
DR. ANGELO SEBASTIAN DOMINGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D
Contact information
Practice address
9926 52ND ST E, PARRISH, FL 34219-4417
(941) 822-6122
Mailing address
9926 52ND ST E, PARRISH, FL 34219-4417
(941) 822-6122
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY7379
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AA931
MEDICARE PTAN
—
Enumeration date
02/21/2007
Last updated
04/20/2010
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