MEDICARE: ERIKA DOMINGUEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1770070104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIKA DOMINGUEZ

Provider Business Mailing Address
First Line	:	2005 TRAWOOD DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79935-3501
Country	:	US
Telephone Number	:	915-346-4451
Fax Number	:

Provider Business Practice Location Address
First Line	:	2005 TRAWOOD DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79935-3501
Country	:	US
Telephone Number	:	915-346-4451
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2018
Last Update Date	:	04/20/2018

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Directions to “ ERIKA DOMINGUEZ ” Practice Location

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