Individual
ANISSA DOMINGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
100 N PARK RD APT 1263, WYOMISSING, PA 19610-3058
(410) 693-7747
Mailing address
100 N PARK RD APT 1263, WYOMISSING, PA 19610-3058
(410) 693-7747
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A00122095
USAA
—
Enumeration date
05/03/2018
Last updated
05/03/2018
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