Provider Demographics
NPI:1265023857
Name:VALLE DOMINGUEZ, BLANCA ANGELICA (RBT)
Entity Type:Individual
Prefix:
First Name:BLANCA
Middle Name:ANGELICA
Last Name:VALLE DOMINGUEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:BLANCA
Other - Middle Name:
Other - Last Name:DOMINGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RBT
Mailing Address - Street 1:13135 BARTON RD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-2757
Mailing Address - Country:US
Mailing Address - Phone:562-944-2794
Mailing Address - Fax:
Practice Address - Street 1:13135 BARTON RD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-2757
Practice Address - Country:US
Practice Address - Phone:714-454-9721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABACB578101106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician