Provider Demographics
NPI:1407391303
Name:DOMINGUEZ, ALEXANDER (BCBA)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7612 HERRICKS LOOP
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-1094
Mailing Address - Country:US
Mailing Address - Phone:786-261-6810
Mailing Address - Fax:
Practice Address - Street 1:7612 HERRICKS LOOP
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-1094
Practice Address - Country:US
Practice Address - Phone:407-504-0660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-30
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-22-62715103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst