Provider Demographics
NPI:1528555752
Name:MEDINA DOMINGUEZ, SONIA
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:MEDINA 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 1:271 SW 47TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1465
Mailing Address - Country:US
Mailing Address - Phone:786-334-0797
Mailing Address - Fax:
Practice Address - Street 1:271 SW 47TH AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1465
Practice Address - Country:US
Practice Address - Phone:786-334-0797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty