MEDICARE: ROSANA PEREZ 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-25-433997	FL

General Provider Information

NPI Number	:	1568253953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSANA PEREZ DOMINGUEZ

Provider Business Mailing Address
First Line	:	344 PONTE VEDRA RD
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-1821
Country	:	US
Telephone Number	:	561-714-1273
Fax Number	:

Provider Business Practice Location Address
First Line	:	344 PONTE VEDRA RD
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-1821
Country	:	US
Telephone Number	:	561-714-1273
Fax Number	:

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

Provider Enumeration Date	:	05/14/2025
Last Update Date	:	03/09/2026

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Directions to “ ROSANA PEREZ DOMINGUEZ ” Practice Location

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