Provider Demographics
NPI:1679990022
Name:SALGADO DOMINGUEZ, ROGER I (BCBA)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:I
Last Name:SALGADO DOMINGUEZ
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:ROGER
Other - Middle Name:
Other - Last Name:SALGADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:18230 FM 1488 RD STE 104
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-4529
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18230 FM 1488 RD STE 104
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-4529
Practice Address - Country:US
Practice Address - Phone:832-632-3998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-18-30260103K00000X
TX3594103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX489299401Medicaid