Provider Demographics
NPI:1467805366
Name:TAPANES DOMINGUEZ, ARIEL
Entity type:Individual
Prefix:
First Name:ARIEL
Middle Name:
Last Name:TAPANES DOMINGUEZ
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 1:408 STEWART PARK LN
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-7729
Mailing Address - Country:US
Mailing Address - Phone:786-620-7367
Mailing Address - Fax:
Practice Address - Street 1:5212 LAKE MARGARET DR
Practice Address - Street 2:APT 1210
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-6113
Practice Address - Country:US
Practice Address - Phone:786-620-7367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-15
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst