MEDICARE: JENNIFER AILEEN THEILE DOMINGUEZ RBT

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	106S00000X	Behavior Technician	RBT-20-127669	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	:	1780385930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER AILEEN THEILE DOMINGUEZ RBT

Provider Business Mailing Address
First Line	:	15132 SW 104TH ST APT 211
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33196-3285
Country	:	US
Telephone Number	:	786-239-0880
Fax Number	:

Provider Business Practice Location Address
First Line	:	9245 SW 158TH LN
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33157-1804
Country	:	US
Telephone Number	:	786-239-0880
Fax Number	:

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

Provider Enumeration Date	:	03/14/2023
Last Update Date	:	03/25/2026

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Directions to “ JENNIFER AILEEN THEILE DOMINGUEZ RBT” Practice Location

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