Provider Demographics
NPI:1235921586
Name:DHOMBE, HAMZA
Entity type:Individual
Prefix:
First Name:HAMZA
Middle Name:
Last Name:DHOMBE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 INDUSTRIAL DR S STE 109
Mailing Address - Street 2:
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379-1271
Mailing Address - Country:US
Mailing Address - Phone:320-267-7001
Mailing Address - Fax:
Practice Address - Street 1:940 INDUSTRIAL DR S STE 109
Practice Address - Street 2:
Practice Address - City:SAUK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56379-1271
Practice Address - Country:US
Practice Address - Phone:320-267-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician