Healthcare Provider Details

I. General information

NPI: 1043140445
Provider Name (Legal Business Name): DIEGO ACEVEDO DOMINGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6560 W 24TH CT APT 13
HIALEAH FL
33016-7811
US

IV. Provider business mailing address

6560 W 24TH CT APT 13
HIALEAH FL
33016-7811
US

V. Phone/Fax

Practice location:
  • Phone: 305-525-1072
  • Fax:
Mailing address:
  • Phone: 305-525-1072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-528917
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: