Provider Demographics
NPI:1407527567
Name:HERNANDEZ DOMINGUEZ, LIANET
Entity Type:Individual
Prefix:
First Name:LIANET
Middle Name:
Last Name:HERNANDEZ 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 1:3961 POT O GOLD ST
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-4965
Mailing Address - Country:US
Mailing Address - Phone:561-234-5599
Mailing Address - Fax:
Practice Address - Street 1:3961 POT O GOLD ST
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-4965
Practice Address - Country:US
Practice Address - Phone:561-234-5599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician