Provider Demographics
NPI:1437656071
Name:DOMINGUEZ HERNANDEZ, ARACELY D
Entity Type:Individual
Prefix:
First Name:ARACELY
Middle Name:D
Last Name:DOMINGUEZ HERNANDEZ
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 1:9810 SW 54TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7218
Mailing Address - Country:US
Mailing Address - Phone:786-474-7981
Mailing Address - Fax:
Practice Address - Street 1:9810 SW 54TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7218
Practice Address - Country:US
Practice Address - Phone:786-474-7981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty