Provider Demographics
NPI:1679920664
Name:DOMINGUEZ LEMUS, BEATRIZ
Entity type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:
Last Name:DOMINGUEZ LEMUS
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 1:7509 W 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-5237
Mailing Address - Country:US
Mailing Address - Phone:786-683-4033
Mailing Address - Fax:
Practice Address - Street 1:7509 W 31ST AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-5237
Practice Address - Country:US
Practice Address - Phone:786-683-4033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-19
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other