MEDICARE: CANDIDA DOMINGUEZ

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	225X00000X	Occupational Therapist	OT12184	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740239474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDIDA DOMINGUEZ

Provider Business Mailing Address
First Line	:	15333 SW 32ND TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-4794
Country	:	US
Telephone Number	:	305-559-4840
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 WEST AVE
Second Line	:	#1411
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-4759
Country	:	US
Telephone Number	:	305-778-9198
Fax Number	:

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

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	07/08/2007

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Directions to “ CANDIDA DOMINGUEZ ” Practice Location

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