Active NPI
Dominique Gary, BCBA
- Behavior Analyst
- Murrieta, CA
National Provider Identifier
1245871086
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 11938585
- Practice address
- 28316 Triese St
Murrieta, CA 92563-4406 - Phone
- (949) 427-8821
- Fax
- (949) 202-0360
- NPI assigned
- Oct 2, 2019
- Last updated
- Oct 1, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 11938585 | CA | Primary |
Addresses
Primary practice location
28316 Triese St
Murrieta, CA 92563-4406
Mailing address
28316 Triese St
Murrieta, CA 92563-4406
Phone (949) 427-8821
Other practice location 1
3350 Shelby St Ste 200
Ontario, CA 91764-5556
Phone (949) 427-8821
Other practice location 2
433 Tivoli Ct
Hemet, CA 92543-8729
Phone (949) 427-8821
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11938585 | CA | MD | Behavioral Analyst |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| MLG Investment Group | Behavior Analyst | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1569974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727740800000",
"number": "1245871086",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "28316 TRIESE ST",
"city": "MURRIETA",
"state": "CA",
"postal_code": "925634406",
"telephone_number": "949-427-8821",
"fax_number": "949-202-0360"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "28316 TRIESE ST",
"city": "MURRIETA",
"state": "CA",
"postal_code": "925634406",
"telephone_number": "949-427-8821",
"fax_number": "949-202-0360"
}
],
"practiceLocations": [
{
"address_1": "3350 Shelby St Ste 200",
"address_purpose": "LOCATION",
"city": "Ontario",
"state": "CA",
"postal_code": "917645556",
"country_code": "US",
"telephone_number": "949-427-8821",
"fax_number": "949-202-0360",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "433 Tivoli Ct",
"address_purpose": "LOCATION",
"city": "Hemet",
"state": "CA",
"postal_code": "925438729",
"country_code": "US",
"telephone_number": "949-427-8821",
"fax_number": "949-202-0360",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GARY",
"first_name": "DOMINIQUE",
"credential": "BCBA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-10-02",
"last_updated": "2024-10-01",
"certification_date": "2024-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "CA",
"license": "11938585",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Murrieta, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.