| Doctor Name: | MRS. MARIA I DOMINGUEZ |
| NPI Number: | 1174786974 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 0620362 |
| Business Practice Address: | 122 Park Ave Williston Park, NY - 115961630 |
| Business Phone Number: | 5162486413 |
| Business Fax Number: | |
| Mailing Address: | 122 Park Ave, WILLISTON PARK |
| State: | NY |
| Postal Code: | 115961630 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 07/02/2008 |
| NPI Last Update Date: | 07/02/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2355S0801X |
| License Number: | 0620362 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Specialist/Technologist |
| Taxonomy Specialization: | Speech-Language Assistant |
| Taxonomy Definition: | |