Provider Demographics
NPI:1073386348
Name:PELAEZ DOMINGUEZ, HECTOR CARLOS
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:CARLOS
Last Name:PELAEZ DOMINGUEZ
Suffix:
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 1:18212 SW 144TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-3317
Mailing Address - Country:US
Mailing Address - Phone:786-832-3750
Mailing Address - Fax:
Practice Address - Street 1:18212 SW 144TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-3317
Practice Address - Country:US
Practice Address - Phone:786-832-3750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1010818106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician