Provider Demographics
NPI:1417715905
Name:DOMINGUEZ BERMUDEZ, DAINIER
Entity Type:Individual
Prefix:
First Name:DAINIER
Middle Name:
Last Name:DOMINGUEZ BERMUDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2388 55TH TER SW APT B
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34116-5697
Mailing Address - Country:US
Mailing Address - Phone:239-269-1565
Mailing Address - Fax:
Practice Address - Street 1:2388 55TH TER SW APT B
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116-5697
Practice Address - Country:US
Practice Address - Phone:239-269-1565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician