Individual
DOMONIQUE CHONG PANGELINAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1087 E PARK BLVD, BOISE, ID 83712
(208) 972-5254
Mailing address
2390 N 6TH E, MOUNTAIN HOME, ID 83647-1772
(808) 464-2847
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/10/2024
Last updated
04/10/2024
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