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NPI Code Detail

MEDICARE: BROOKE DOMINGUEZ

MEDICARE: BROOKE 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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1902594377
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROOKE DOMINGUEZ
Provider Business Mailing Address
First Line : 1313 W PARKWOOD AVE STE 101
Second Line :
City : FRIENDSWOOD
State : TX
Zip : 77546-5701
Country : US
Telephone Number : 281-947-8925
Fax Number : 281-310-8803
Provider Business Practice Location Address
First Line : 1313 W PARKWOOD AVE STE 101
Second Line :
City : FRIENDSWOOD
State : TX
Zip : 77546-5701
Country : US
Telephone Number : 281-947-8925
Fax Number : 281-310-8803
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2023
Last Update Date : 04/25/2023

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Directions to “ BROOKE DOMINGUEZ ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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