MEDICARE: DOMINIQUE ZANAYVIA BEGELTON

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
1	106S00000X	Behavior Technician	RBT-23-298439	TX

General Provider Information

NPI Number	:	1659150431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINIQUE ZANAYVIA BEGELTON

Provider Business Mailing Address
First Line	:	16378 PAITER ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77053-4420
Country	:	US
Telephone Number	:	832-291-7771
Fax Number	:

Provider Business Practice Location Address
First Line	:	12246 QUEENSTON BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-5354
Country	:	US
Telephone Number	:	832-291-7771
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2023
Last Update Date	:	09/21/2023

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Directions to “ DOMINIQUE ZANAYVIA BEGELTON ” Practice Location

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