Provider Demographics
NPI:1437682762
Name:DOMINGUEZ, PEDRO (RBT)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18940 NW 86TH AVE APT 3603
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-7230
Mailing Address - Country:US
Mailing Address - Phone:786-225-0443
Mailing Address - Fax:305-647-2912
Practice Address - Street 1:18940 NW 86TH AVE APT 3603
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-7230
Practice Address - Country:US
Practice Address - Phone:786-225-0443
Practice Address - Fax:305-647-2912
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician