Individual
JESSICA DOMINGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
636 SITKA DR, WALNUT CREEK, CA 94598-1738
(925) 705-9100
Mailing address
636 SITKA DR, WALNUT CREEK, CA 94598-1738
(925) 705-9100
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000018462
CA
Other
Enumeration date
03/28/2017
Last updated
03/28/2017
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