MEDICARE: JULAISY 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	106S00000X	Behavior Technician	RBT-24-399962	FL
2	225700000X	Massage Therapist	MA63116	FL

General Provider Information

NPI Number	:	1245523471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULAISY DOMINGUEZ

Provider Business Mailing Address
First Line	:	2265 SW 148TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-5623
Country	:	US
Telephone Number	:	954-266-9782
Fax Number	:

Provider Business Practice Location Address
First Line	:	2265 SW 148TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-5623
Country	:	US
Telephone Number	:	954-266-9782
Fax Number	:

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

Provider Enumeration Date	:	05/20/2011
Last Update Date	:	02/05/2025

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Directions to “ JULAISY DOMINGUEZ ” Practice Location

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