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General NPI Number Information
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NPI Number | 1104279256
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Entity Type | Individual
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Provider Name | ROXANA N MONSIVAIS DOMINGUEZ
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Gender | Female
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Dates
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Enumeration Date | 07/13/2016
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 2920 S JONES BLVD STE 225
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City | LAS VEGAS
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State | NV
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Zip | 89146-5622
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Country | US
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Telephone | 702-476-6395
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Fax |
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Provider Business Mailing Address
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Address Line | 764 E TWAIN AVE APT 15G
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City | LAS VEGAS
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State | NV
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Zip | 89169-4127
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Country | US
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Telephone | 702-334-7769
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1104279256
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 1104279256
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License Number State | NV
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