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1720633050
VIRCELITO A. DOMENDEN
SAN MATEO, CA
NPI
1720633050
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2019-08-05
Last Update Date
2019-08-05
Business Address
VIRCELITO A. DOMENDEN
900 LAUREL AVE
SAN MATEO, CA 94401-4211
Phone number: 650-293-9407
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Mailing Address
VIRCELITO A. DOMENDEN
30685 UNION CITY BLVD
UNION CITY, CA 94587-2546
Phone number: 510-502-8589
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