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General NPI Number Information
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NPI Number | 1518767557
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Entity Type | Individual
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Provider Name | GENESIS ANAHI DOMINGUEZ RBT-24-365295
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Gender |
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Dates
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Enumeration Date | 03/18/2025
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 10789 BRADFORD RD STE 150
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City | LITTLETON
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State | CO
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Zip | 80127-6405
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Country | US
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Telephone | 720-379-9171
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Fax |
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Provider Business Mailing Address
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Address Line | 2405 PALMER CIR STE 100
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City | NORMAN
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State | OK
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Zip | 73069-6351
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Country | US
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Telephone |
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-24-365295
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License Number State | CO
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