Individual
JOSE INES MEJIA DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2085 RUSTIN AVE # 5, RIVERSIDE, CA 92507-2498
(951) 509-2400
(951) 509-2405
Mailing address
9890 COUNTY FARM RD STE 3, RIVERSIDE, CA 92503-3678
(951) 509-2499
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
07/18/2022
Last updated
12/26/2024
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