Healthcare Provider Details

I. General information

NPI: 1386136919
Provider Name (Legal Business Name): DOMINIQUE MICOLE MCCREE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6876 MAGNOLIA AVE
RIVERSIDE CA
92506-2860
US

IV. Provider business mailing address

6876 MAGNOLIA AVE
RIVERSIDE CA
92506-2860
US

V. Phone/Fax

Practice location:
  • Phone: 760-992-3039
  • Fax:
Mailing address:
  • Phone: 760-992-3039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: