Provider Demographics
NPI:1447913140
Name:DOMINACH, CASSIE (DACM, LAC)
Entity type:Individual
Prefix:DR
First Name:CASSIE
Middle Name:
Last Name:DOMINACH
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3565 DEL REY ST STE 207
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-5703
Mailing Address - Country:US
Mailing Address - Phone:732-687-0985
Mailing Address - Fax:
Practice Address - Street 1:3565 DEL REY ST STE 207
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-5703
Practice Address - Country:US
Practice Address - Phone:732-687-0985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19081171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist