Provider Demographics
NPI:1356856942
Name:DOMINGUEZ GONZALEZ, DAYANA ANNETIS
Entity Type:Individual
Prefix:
First Name:DAYANA
Middle Name:ANNETIS
Last Name:DOMINGUEZ GONZALEZ
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 1:5751 NW 114TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-6609
Mailing Address - Country:US
Mailing Address - Phone:786-237-6042
Mailing Address - Fax:
Practice Address - Street 1:65 E 44TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-1815
Practice Address - Country:US
Practice Address - Phone:786-237-6042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-05
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-95431106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician