MEDICARE: CARLOS MIGUEL DOMENECH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	D552-113-06-424-0	FL

General Provider Information

NPI Number	:	1063343424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS MIGUEL DOMENECH

Provider Business Mailing Address
First Line	:	14385 SW 45TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-6844
Country	:	US
Telephone Number	:	786-310-9482
Fax Number	:

Provider Business Practice Location Address
First Line	:	14385 SW 45TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-6844
Country	:	US
Telephone Number	:	786-310-9482
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2026
Last Update Date	:	05/26/2026

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Directions to “ CARLOS MIGUEL DOMENECH ” Practice Location

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