Healthcare Provider Details

I. General information

NPI: 1245735026
Provider Name (Legal Business Name): DAYANA MARLEN DOMINGUEZ BATISTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 03/09/2024
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 S DOBSON RD STE 509
MESA AZ
85202-4778
US

IV. Provider business mailing address

7931 E SAN MIGUEL AVE UNIT 2
SCOTTSDALE AZ
85250-6557
US

V. Phone/Fax

Practice location:
  • Phone: 480-412-6430
  • Fax:
Mailing address:
  • Phone: 786-495-3130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number66177
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number66177
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number66177
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: