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NPI Code Detail

MEDICARE: DOMINIQUE GRAY

MEDICARE: DOMINIQUE GRAY
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 : 1518810084
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOMINIQUE GRAY
Provider Business Mailing Address
First Line : 2550 N HOLLYWOOD WAY STE 301
Second Line :
City : BURBANK
State : CA
Zip : 91505-5025
Country : US
Telephone Number : 866-727-8274
Fax Number :
Provider Business Practice Location Address
First Line : 4839 N ELSTON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60630-2534
Country : US
Telephone Number : 866-727-8274
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2026
Last Update Date : 02/16/2026

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Directions to “ DOMINIQUE GRAY ” Practice Location

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