Individual
THOMAS PAUL DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
625 TRUMAN ST NE, ALBUQUERQUE, NM 87110-6443
(505) 938-7146
Mailing address
2516 MAIDEN GRASS RD NW, ALBUQUERQUE, NM 87120-6238
(505) 938-7146
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
0859
NM
103TC0700X
Clinical Psychologist
Primary
0859
NM
Other
Enumeration date
10/02/2007
Last updated
10/02/2007
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