Provider Demographics
NPI:1184224370
Name:DOMINGUEZ, YAISEL LUCIA
Entity Type:Individual
Prefix:
First Name:YAISEL
Middle Name:LUCIA
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15350 SW 73RD TERRACE CIR APT 2
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-2227
Mailing Address - Country:US
Mailing Address - Phone:786-468-3200
Mailing Address - Fax:
Practice Address - Street 1:15350 SW 73RD TERRACE CIR APT 2
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-2227
Practice Address - Country:US
Practice Address - Phone:786-468-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician