Individual
DOMINIQUE BUENAVIDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3150 N WINDING BROOK RD, FLAGSTAFF, AZ 86001-0972
(928) 774-7106
Mailing address
800 W FOREST MEADOWS ST APT 121, FLAGSTAFF, AZ 86001-2903
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5102
AZ
Other
Enumeration date
04/26/2013
Last updated
04/26/2013
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