Active NPI
Dominique Banks
- Behavior Technician
- La Mesa, CA
National Provider Identifier
1902671423
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 23-9220-535283
- Practice address
- 8270 La Mesa Blvd Ste 202
La Mesa, CA 91942-5216 - Phone
- (619) 713-0737
- NPI assigned
- Nov 15, 2023
- 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 Technician | 106S00000X | 23-9220-535283 | CA | Primary |
Addresses
Primary practice location
8270 La Mesa Blvd Ste 202
La Mesa, CA 91942-5216
Mailing address
3920 60TH St Unit 98
San Diego, CA 92115-6504
Phone (619) 415-5636
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 |
|---|---|---|---|
| 23-9220-535283 | CA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1700006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1700006400000",
"number": "1902671423",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3920 60TH ST UNIT 98",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921156504",
"telephone_number": "619-415-5636"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8270 LA MESA BLVD STE 202",
"city": "LA MESA",
"state": "CA",
"postal_code": "919425216",
"telephone_number": "619-713-0737"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BANKS",
"first_name": "DOMINIQUE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-11-15",
"last_updated": "2023-11-15",
"certification_date": "2023-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CA",
"license": "23-9220-535283",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Mesa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.