Active NPI
Mayriulis Dominguez
- Behavior Technician
- Hialeah, FL
National Provider Identifier
1639622822
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 16-23420
- Practice address
- 2782 W 54TH PL
Hialeah, FL 33016-4081 - Phone
- (786) 973-1887
- NPI assigned
- Jul 25, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 16-23420 | FL | Primary |
Addresses
Primary practice location
2782 W 54TH PL
Hialeah, FL 33016-4081
Mailing address
2782 W 54TH PL
Hialeah, FL 33016-4081
Phone (786) 973-1887
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16-23420 | FL | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1469404800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1647388800000",
"number": "1639622822",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2782 W 54TH PL",
"city": "HIALEAH",
"state": "FL",
"postal_code": "330164081",
"telephone_number": "786-973-1887"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2782 W 54TH PL",
"city": "HIALEAH",
"state": "FL",
"postal_code": "330164081",
"telephone_number": "786-973-1887"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMINGUEZ",
"first_name": "MAYRIULIS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-07-25",
"last_updated": "2022-03-16",
"certification_date": "2022-03-16",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "FL",
"license": "16-23420",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hialeah, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.