Provider Demographics
NPI:1275347536
Name:DOMINGUEZ, YONATAN
Entity type:Individual
Prefix:
First Name:YONATAN
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 N CENTRAL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-3526
Mailing Address - Country:US
Mailing Address - Phone:661-360-6300
Mailing Address - Fax:
Practice Address - Street 1:237 N CENTRAL AVE STE A
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-3526
Practice Address - Country:US
Practice Address - Phone:661-360-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician