Individual
DR. DOMINIC RICHARD PRIME
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
16770 SW EDY RD STE 102, SHERWOOD, OR 97140-9679
(503) 216-9600
Mailing address
1800 HARRISON ST FL 7, OAKLAND, CA 94612-3466
(510) 625-2856
(877) 738-4262
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
3023
OR
103T00000X
Psychologist
Primary
30305
CA
103T00000X
Psychologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500758548
—
OR
Enumeration date
08/01/2017
Last updated
12/29/2021
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