Provider Demographics
NPI:1699117234
Name:DOMINGUEZ, ADANNYS
Entity type:Individual
Prefix:
First Name:ADANNYS
Middle Name:
Last Name:DOMINGUEZ
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 1:14248 SW 100TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6959
Mailing Address - Country:US
Mailing Address - Phone:305-744-4525
Mailing Address - Fax:
Practice Address - Street 1:13205 SW 137TH AVE STE 132
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5334
Practice Address - Country:US
Practice Address - Phone:786-478-6369
Practice Address - Fax:786-429-1704
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA46559225700000X
251S00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No251S00000XAgenciesCommunity/Behavioral Health