Healthcare Provider Details

I. General information

NPI: 1003489691
Provider Name (Legal Business Name): ALYSSA MERCEDES DOMINGUEZ BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 NW 15TH ST
MIAMI FL
33136-1431
US

IV. Provider business mailing address

5131 SW 93RD CT
MIAMI FL
33165-6516
US

V. Phone/Fax

Practice location:
  • Phone: 305-325-1818
  • Fax:
Mailing address:
  • Phone: 305-878-0781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: