Individual
TRISTIN KING DOMINGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
531 BRYDEN AVE, LEWISTON, ID 83501-4438
(208) 798-1646
(208) 798-5568
Mailing address
531 BRYDEN AVE, LEWISTON, ID 83501-4438
(208) 798-1646
(208) 798-5568
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
—
—
Other
Enumeration date
02/10/2026
Last updated
02/10/2026
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