Provider Demographics
NPI:1609639442
Name:DOMINGUEZ LOPEZ, LUIS I (RBT)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:DOMINGUEZ LOPEZ
Suffix:I
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 W 35TH ST APT 307
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4984
Mailing Address - Country:US
Mailing Address - Phone:754-272-7312
Mailing Address - Fax:
Practice Address - Street 1:1199 W 35TH ST APT 307
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4984
Practice Address - Country:US
Practice Address - Phone:754-272-7312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician