Healthcare Provider Details

I. General information

NPI: 1780358770
Provider Name (Legal Business Name): DOMINIQUE STRONG AAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 N GREENFIELD RD
MESA AZ
85205-7840
US

IV. Provider business mailing address

11 OVERLOOK RIDGE DR # AR20099
REVERE MA
02151-1123
US

V. Phone/Fax

Practice location:
  • Phone: 818-805-8015
  • Fax:
Mailing address:
  • Phone: 818-805-8015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: