Healthcare Provider Details

I. General information

NPI: 1013759125
Provider Name (Legal Business Name): DOMENICA PAULINA CUADROS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25295 SW 114TH CT
HOMESTEAD FL
33032-4718
US

IV. Provider business mailing address

25295 SW 114TH CT
HOMESTEAD FL
33032-4718
US

V. Phone/Fax

Practice location:
  • Phone: 786-332-8368
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-349299
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: