Provider Demographics
NPI:1861720492
Name:DOMINGO, LAMBERTO SAMODIO (PSYD)
Entity type:Individual
Prefix:DR
First Name:LAMBERTO
Middle Name:SAMODIO
Last Name:DOMINGO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9260 LAGUNA SPRINGS DR RM 330
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-7947
Mailing Address - Country:US
Mailing Address - Phone:916-691-5895
Mailing Address - Fax:559-934-3461
Practice Address - Street 1:24511 W JAYNE AVE
Practice Address - Street 2:
Practice Address - City:COALINGA
Practice Address - State:CA
Practice Address - Zip Code:93210-9503
Practice Address - Country:US
Practice Address - Phone:559-934-3088
Practice Address - Fax:559-934-3461
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-19
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
CAPSY22388103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist