MEDICARE: KEILA DOMINGUEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SA23716	FL

General Provider Information

NPI Number	:	1023507886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEILA DOMINGUEZ

Provider Business Mailing Address
First Line	:	9119 CHAMBERS ST
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33321-4147
Country	:	US
Telephone Number	:	786-338-8335
Fax Number	:

Provider Business Practice Location Address
First Line	:	9119 CHAMBERS ST
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33321-4147
Country	:	US
Telephone Number	:	786-338-8335
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2018
Last Update Date	:	01/08/2026

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Directions to “ KEILA DOMINGUEZ ” Practice Location

Language	Start Address	Practice Location

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