Most Relevant Information
Provider Data
| NPI Number: | 1003461526 |
| Provider Name: | DOMINIQUE DOUGLAS |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/02/2019 |
| Last Updated: | 08/02/2019 |
Provider Practice Location
9600 NW 25TH ST STE PH
DORAL
FL
331721416
Practice Location Phone/Fax
| Phone: | 3055973861 |
| Fax: | 3055973863 |
Provider Mailing Location
9600 NW 25TH ST STE PH
DORAL
FL
331721416
Provider Mailing Phone/Fax
| Phone: | 3055973861 |
| Fax: | 3055973863 |