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General NPI Number Information
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NPI Number | 1154119352
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Entity Type | Individual
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Provider Name | ELIEL DAVID LOPEZ DOMINGUEZ
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Gender | Male
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Dates
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Enumeration Date | 04/28/2025
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 1700 SW 57TH AVE STE 209
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City | MIAMI
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State | FL
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Zip | 33155-2163
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Country | US
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Telephone | 786-558-4981
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Fax |
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Provider Business Mailing Address
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Address Line | 11378 W FLAGLER ST APT 106
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City | MIAMI
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State | FL
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Zip | 33174-1190
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Country | US
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Telephone | 305-904-2835
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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