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NPI Code Detail

MEDICARE: DOMINIQUE BROWN

MEDICARE: DOMINIQUE BROWN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1184360455
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOMINIQUE BROWN
Provider Business Mailing Address
First Line : 4038 CHATSWORTH CIR
Second Line :
City : STOCKTON
State : CA
Zip : 95209-1561
Country : US
Telephone Number : 209-594-9067
Fax Number :
Provider Business Practice Location Address
First Line : 1811 GRAND CANAL BLVD
Second Line :
City : STOCKTON
State : CA
Zip : 95207-8155
Country : US
Telephone Number : 877-418-2978
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2022
Last Update Date : 05/10/2022

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Directions to “ DOMINIQUE BROWN ” Practice Location

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