Healthcare Provider Details

I. General information

NPI: 1568337236
Provider Name (Legal Business Name): AZUCENA DOMINGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2025
Last Update Date: 10/10/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 E KENYON AVE STE 3200
DENVER CO
80237-1855
US

IV. Provider business mailing address

9101 E KENYON AVE SUITE 3200
DENVER CO
80237
US

V. Phone/Fax

Practice location:
  • Phone: 720-961-3764
  • Fax:
Mailing address:
  • Phone: 970-343-6717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: