Provider Demographics
NPI:1992050660
Name:DOMINGUEZ, SAXONY DIANE (BCBA)
Entity type:Individual
Prefix:MRS
First Name:SAXONY
Middle Name:DIANE
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3309 C STREET
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-2862
Mailing Address - Country:US
Mailing Address - Phone:916-442-2396
Mailing Address - Fax:916-442-2525
Practice Address - Street 1:4064 HILLSWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-2862
Practice Address - Country:US
Practice Address - Phone:916-835-0742
Practice Address - Fax:916-442-2525
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-09-5664103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst