Provider Demographics
NPI:1548921455
Name:DOMINGUEZ, HANNAH CHRISTINE
Entity type:Individual
Prefix:MS
First Name:HANNAH
Middle Name:CHRISTINE
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7912 OSTROW ST STE A
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-3605
Mailing Address - Country:US
Mailing Address - Phone:858-300-8284
Mailing Address - Fax:858-300-8284
Practice Address - Street 1:7917 OSTROW ST STE A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-3604
Practice Address - Country:US
Practice Address - Phone:858-300-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA145609106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist