Individual
SAMANTHA S DOMINGUES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
18350 MOUNT LANGLEY ST STE 105, FOUNTAIN VALLEY, CA 92708-6923
(714) 965-2324
(714) 965-2684
Mailing address
18350 MOUNT LANGLEY ST STE 105, FOUNTAIN VALLEY, CA 92708-6923
(714) 965-2324
(714) 965-2684
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2068
CA
Other
Enumeration date
07/19/2012
Last updated
07/19/2012
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