Individual
KIANA DOMENIK-ALEXIS DINIZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
800 COFFEE RD, MODESTO, CA 95355-4233
(209) 554-6808
Mailing address
800 COFFEE RD, MODESTO, CA 95355-4233
(209) 554-6808
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
148764
CA
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/27/2019
Last updated
03/09/2025
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