MEDICARE: FRANCISCO JOSE DOMINICCI CRT

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	2278C0205X	Critical Care Certified Respiratory Therapist	TT 13235	FL

General Provider Information

NPI Number	:	1598887655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRANCISCO JOSE DOMINICCI CRT

Provider Business Mailing Address
First Line	:	6700 NW 186TH ST
Second Line	:	APT.412
City	:	HIALEAH
State	:	FL
Zip	:	33015-3308
Country	:	US
Telephone Number	:	786-340-4136
Fax Number	:

Provider Business Practice Location Address
First Line	:	6700 NW 186TH ST
Second Line	:	APT.412
City	:	HIALEAH
State	:	FL
Zip	:	33015-3308
Country	:	US
Telephone Number	:	786-340-4136
Fax Number	:

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

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	07/19/2009

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