MEDICARE: NATALIE 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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1881292175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE DOMINGUEZ

Provider Business Mailing Address
First Line	:	4701 E MARGARET DR
Second Line	:
City	:	TERRE HAUTE
State	:	IN
Zip	:	47803-9303
Country	:	US
Telephone Number	:	317-334-7331
Fax Number	:	317-334-7336

Provider Business Practice Location Address
First Line	:	4701 E MARGARET DR
Second Line	:
City	:	TERRE HAUTE
State	:	IN
Zip	:	47803-9303
Country	:	US
Telephone Number	:	317-334-7331
Fax Number	:	317-334-7336

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

Provider Enumeration Date	:	10/09/2020
Last Update Date	:	10/09/2020

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Directions to “ NATALIE DOMINGUEZ ” Practice Location

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