Healthcare Provider Details

I. General information

NPI: 1275368227
Provider Name (Legal Business Name): ARIANNA DOMINGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 VIA LUGANO CIR APT 211
BOYNTON BEACH FL
33436-7169
US

IV. Provider business mailing address

500 VIA LUGANO CIR APT 211
BOYNTON BEACH FL
33436-7169
US

V. Phone/Fax

Practice location:
  • Phone: 561-788-1374
  • Fax:
Mailing address:
  • Phone: 561-788-1374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberD552-000-97-949-0
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberD552000979490
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: