Healthcare Provider Details

I. General information

NPI: 1245144658
Provider Name (Legal Business Name): DAVID YAIR DOMINGUEZ RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5360 STONEHURST DR
MARTINEZ CA
94553-9721
US

IV. Provider business mailing address

318 KINGSTON AVE
MARTINEZ CA
94553-4048
US

V. Phone/Fax

Practice location:
  • Phone: 510-501-2385
  • Fax:
Mailing address:
  • Phone: 925-826-9477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: