Healthcare Provider Details

I. General information

NPI: 1356973721
Provider Name (Legal Business Name): YEIDY DOMINGUES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 09/18/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5370 W 23RD CT
HIALEAH FL
33016-2027
US

IV. Provider business mailing address

13880 SW 150TH CT
MIAMI FL
33196-5037
US

V. Phone/Fax

Practice location:
  • Phone: 786-901-4630
  • Fax:
Mailing address:
  • Phone: 786-901-4630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: