MEDICARE: YALIAGNY DOMINGUEZ TAMAYO

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	106S00000X	Behavior Technician	RBT-22-213430	FL
2	106E00000X	Assistant Behavior Analyst	0-25-16291	FL

General Provider Information

NPI Number	:	1942944954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YALIAGNY DOMINGUEZ TAMAYO

Provider Business Mailing Address
First Line	:	946 BIGNONIA RD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33405-2404
Country	:	US
Telephone Number	:	561-690-7614
Fax Number	:

Provider Business Practice Location Address
First Line	:	1028 N FEDERAL HWY
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-2352
Country	:	US
Telephone Number	:	561-690-7614
Fax Number	:

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

Provider Enumeration Date	:	04/25/2022
Last Update Date	:	07/20/2025

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