Individual
DOMENICA FONSECA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1111 86TH AVE UNIT C204, GREELEY, CO 80634-9091
(626) 456-2450
Mailing address
172 W REDWOOD CT, COVINA, CA 91723-2679
(626) 456-2450
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
—
—
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/22/2021
Last updated
07/22/2021
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