Healthcare Provider Details

I. General information

NPI: 1295651925
Provider Name (Legal Business Name): RAUL ENRIQUE SALCEIRO DOMINGUEZ RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4331 SW 6TH ST
CORAL GABLES FL
33134-1907
US

IV. Provider business mailing address

4331 SW 6TH ST
CORAL GABLES FL
33134-1907
US

V. Phone/Fax

Practice location:
  • Phone: 786-464-2070
  • Fax:
Mailing address:
  • Phone: 786-464-2070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number26-544220
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: