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General NPI Number Information
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NPI Number | 1740239474
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Entity Type | Individual
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Provider Name | CANDIDA DOMINGUEZ
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Gender | Female
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1000 WEST AVE #1411
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City | MIAMI BEACH
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State | FL
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Zip | 33139-4759
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Country | US
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Telephone | 305-778-9198
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Fax |
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Provider Business Mailing Address
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Address Line | 15333 SW 32ND TER
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City | MIAMI
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State | FL
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Zip | 33185-4794
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Country | US
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Telephone | 305-559-4840
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT12184
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License Number State | FL
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