Provider Demographics
NPI:1932611902
Name:DOMINGUEZ GONZALEZ, LILIET
Entity Type:Individual
Prefix:
First Name:LILIET
Middle Name:
Last Name:DOMINGUEZ GONZALEZ
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 1:10352 SW 212TH ST APT 208
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-3084
Mailing Address - Country:US
Mailing Address - Phone:786-371-5982
Mailing Address - Fax:
Practice Address - Street 1:10352 SW 212TH ST APT 208
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-3084
Practice Address - Country:US
Practice Address - Phone:786-371-5982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-31
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst