Provider Demographics
NPI:1871313171
Name:SALGADO DOMINGUEZ, RUBEN A (PMHNP)
Entity type:Individual
Prefix:
First Name:RUBEN
Middle Name:A
Last Name:SALGADO DOMINGUEZ
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 STATE ST APT 73
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-2169
Mailing Address - Country:US
Mailing Address - Phone:626-625-9295
Mailing Address - Fax:
Practice Address - Street 1:6464 W SUNSET BLVD STE 740
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90028-8009
Practice Address - Country:US
Practice Address - Phone:424-588-5350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-12
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA950325562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry