Basic Information
| Provider Information | |||||||||
| NPI: | 1730687559 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOLORES | ||||||||
| FirstName: | DESMOND | ||||||||
| MiddleName: | TOM | ||||||||
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| Credential: | RBT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6475 SIERRA LN | ||||||||
| Address2: | |||||||||
| City: | DUBLIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945682796 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039898169 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6475 SIERRA LN | ||||||||
| Address2: | |||||||||
| City: | DUBLIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945682796 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039898169 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2018 | ||||||||
| LastUpdateDate: | 02/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | RBT-17-32965 | CA | Y | 103K00000X | N | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.