Provider Demographics
NPI:1639923204
Name:DOMINGUEZ GONZALEZ, PIERO ARLES
Entity Type:Individual
Prefix:
First Name:PIERO
Middle Name:ARLES
Last Name:DOMINGUEZ GONZALEZ
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 1:61 E 53RD TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-1455
Mailing Address - Country:US
Mailing Address - Phone:305-926-2980
Mailing Address - Fax:
Practice Address - Street 1:61 E 53RD TER
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-1455
Practice Address - Country:US
Practice Address - Phone:305-926-2980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-327411106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician