MEDICARE: YANET LILIEN DOMINGUEZ HERNANDEZ RBT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	RBT-20-126196	FL

General Provider Information

NPI Number	:	1356957187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YANET LILIEN DOMINGUEZ HERNANDEZ RBT

Provider Business Mailing Address
First Line	:	6745 SW 132ND AVE APT 307
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-2388
Country	:	US
Telephone Number	:	786-366-8087
Fax Number	:

Provider Business Practice Location Address
First Line	:	6745 SW 132ND AVE APT 307
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-2388
Country	:	US
Telephone Number	:	786-366-8087
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2020
Last Update Date	:	09/17/2020

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