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NPI Code Detail

MEDICARE: NICOLE DOMINGO

MEDICARE: NICOLE DOMINGO
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
1106S00000XBehavior TechnicianTX

General Provider Information

NPI Number : 1376472324
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE DOMINGO
Provider Business Mailing Address
First Line : 350 FAIRWAY DR STE 101
Second Line :
City : DEERFIELD BEACH
State : FL
Zip : 33441-1834
Country : US
Telephone Number : 877-418-2978
Fax Number : 866-500-2186
Provider Business Practice Location Address
First Line : 708 MAIN ST FL 10
Second Line :
City : HOUSTON
State : TX
Zip : 77002-3246
Country : US
Telephone Number : 888-880-9244
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2026
Last Update Date : 05/15/2026

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Directions to “ NICOLE DOMINGO ” Practice Location

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