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General NPI Number Information
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NPI Number | 1285491860
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Entity Type | Individual
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Provider Name | STTEPHANIE PEREZ DOMINGUEZ
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Gender | Female
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Dates
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Enumeration Date | 02/29/2024
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Last Update Date | 03/05/2024
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Provider Practice Location Address
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Address Line | 7212 CURRY FORD RD BLDG 3
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City | ORLANDO
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State | FL
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Zip | 32822-5806
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Country | US
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Telephone | 407-574-8471
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Fax |
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Provider Business Mailing Address
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Address Line | 3010 MARTA CIR APT 105
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City | KISSIMMEE
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State | FL
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Zip | 34741-0749
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Country | US
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Telephone | 786-634-9984
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | BACB930263
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License Number State | FL
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