MEDICARE: MILDREY C DOMINGUEZ DE ARMAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1275039687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILDREY C DOMINGUEZ DE ARMAS

Provider Business Mailing Address
First Line	:	217 PALMWOOD CT
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34743-8609
Country	:	US
Telephone Number	:	407-255-3122
Fax Number	:

Provider Business Practice Location Address
First Line	:	3508 WINDY WALK WAY APT 207
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32837-7343
Country	:	US
Telephone Number	:	407-255-3122
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2018
Last Update Date	:	12/30/2024

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