Provider Demographics
NPI:1063393726
Name:DOMINGUEZ, DANIEL SR
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:DOMINGUEZ
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 TIERRA DE PAZ LOOP APT 310
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33993-2548
Mailing Address - Country:US
Mailing Address - Phone:786-890-7265
Mailing Address - Fax:
Practice Address - Street 1:252 TIERRA DE PAZ LOOP APT 310
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33993-2548
Practice Address - Country:US
Practice Address - Phone:786-890-7265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician