Healthcare Provider Details

I. General information

NPI: 1275465148
Provider Name (Legal Business Name): EDUARDO DOMINGUEZ SANCHEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21945 SW 107TH AVE
GOULDS FL
33170-3156
US

IV. Provider business mailing address

21945 SW 107TH AVE A 307
GOULDS FL
33170-3156
US

V. Phone/Fax

Practice location:
  • Phone: 786-447-8839
  • Fax:
Mailing address:
  • Phone: 786-447-8839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-537109
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: