Provider Demographics
NPI:1568260776
Name:DOMINGUEZ HERNANDEZ, MAYLIN ESTHER
Entity type:Individual
Prefix:
First Name:MAYLIN
Middle Name:ESTHER
Last Name:DOMINGUEZ HERNANDEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5824 FOLKSTONE LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-9409
Mailing Address - Country:US
Mailing Address - Phone:308-320-8092
Mailing Address - Fax:
Practice Address - Street 1:5824 FOLKSTONE LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-9409
Practice Address - Country:US
Practice Address - Phone:308-320-8092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-414961106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician