Provider Demographics
NPI:1366726820
Name:DOMINA, RHESA JANELLE
Entity type:Individual
Prefix:MISS
First Name:RHESA
Middle Name:JANELLE
Last Name:DOMINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11540 TUPELO STREET
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NY
Mailing Address - Zip Code:89506-9064
Mailing Address - Country:US
Mailing Address - Phone:775-772-5080
Mailing Address - Fax:775-384-2216
Practice Address - Street 1:11540 TUPELO ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89506-9408
Practice Address - Country:US
Practice Address - Phone:775-772-5080
Practice Address - Fax:775-384-2216
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst