Healthcare Provider Details

I. General information

NPI: 1801442108
Provider Name (Legal Business Name): SABRINA DOMINGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1489 W PALMETTO PARK RD STE 410
BOCA RATON FL
33486-3325
US

IV. Provider business mailing address

5811 NW 72ND WAY
PARKLAND FL
33067-1265
US

V. Phone/Fax

Practice location:
  • Phone: 954-228-5802
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: