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General NPI Number Information
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NPI Number | 1013869098
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Entity Type | Individual
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Provider Name | JACKLYN DOMINGUEZ
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Gender | Female
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Dates
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Enumeration Date | 02/11/2026
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Last Update Date | 02/11/2026
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Provider Practice Location Address
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Address Line | 1128 N FEDERAL HWY STE 107
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City | HOLLYWOOD
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State | FL
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Zip | 33020-3628
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Country | US
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Telephone | 954-795-0672
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Fax |
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Provider Business Mailing Address
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Address Line | 2751 OCEAN CLUB BLVD APT 106
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City | HOLLYWOOD
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State | FL
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Zip | 33019-3930
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Country | US
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Telephone | 954-795-0672
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA106807
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License Number State | FL
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