Provider Demographics
NPI:1164252953
Name:DAVILA-BARAJAS, DOMINIQUE ANTOINETTE
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:ANTOINETTE
Last Name:DAVILA-BARAJAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12112 KAW DR
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66111-1102
Mailing Address - Country:US
Mailing Address - Phone:913-253-6930
Mailing Address - Fax:
Practice Address - Street 1:12112 KAW DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66111-1102
Practice Address - Country:US
Practice Address - Phone:913-253-6930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst