Healthcare Provider Details

I. General information

NPI: 1134656499
Provider Name (Legal Business Name): AIMARA DOMINGUEZ PORRERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 ALCALDE ST E
LEHIGH ACRES FL
33974-9656
US

IV. Provider business mailing address

933 ALCALDE ST E
LEHIGH ACRES FL
33974-9656
US

V. Phone/Fax

Practice location:
  • Phone: 786-413-6792
  • Fax:
Mailing address:
  • Phone: 786-413-6792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: