Healthcare Provider Details

I. General information

NPI: 1083548820
Provider Name (Legal Business Name): MARIZA DOMINGUES COXA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12101 NW 34TH ST
SUNRISE FL
33323-3311
US

IV. Provider business mailing address

12101 NW 34TH ST
SUNRISE FL
33323-3311
US

V. Phone/Fax

Practice location:
  • Phone: 786-387-8079
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberNA
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: