Provider Demographics
NPI:1952821522
Name:AVILA DOMINGUEZ, DARLYN
Entity Type:Individual
Prefix:
First Name:DARLYN
Middle Name:
Last Name:AVILA 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 1:13810 SW 9TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-3015
Mailing Address - Country:US
Mailing Address - Phone:786-501-3173
Mailing Address - Fax:
Practice Address - Street 1:13810 SW 9TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-3015
Practice Address - Country:US
Practice Address - Phone:786-501-3173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician