Individual
MR. RICKY DOMINGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5808 WILLET DR, SANTA TERESA, NM 88008-9521
(915) 204-5625
Mailing address
5808 WILLET DR, SANTA TERESA, NM 88008-9521
(915) 204-5625
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
05/16/2011
Last updated
05/16/2011
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