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General NPI Number Information
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NPI Number | 1992565469
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Entity Type | Individual
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Provider Name | GRISSEL INGRID DOMINGUEZ RBT-24-335203
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Gender | Female
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Dates
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Enumeration Date | 03/20/2024
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Last Update Date | 03/20/2024
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Provider Practice Location Address
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Address Line | 5271 19TH PL SW
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City | NAPLES
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State | FL
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Zip | 34116-6201
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Country | US
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Telephone | 239-241-4798
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Fax |
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Provider Business Mailing Address
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Address Line | 5271 19TH PL SW
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City | NAPLES
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State | FL
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Zip | 34116-6201
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Country | US
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Telephone | 239-241-4798
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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 | D552-289-94-930-0
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License Number State | FL
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