MEDICARE: NERSY 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

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	:	1942781620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NERSY DOMINGUEZ RBT

Provider Business Mailing Address
First Line	:	5734 PAPAYA RD APT S
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33413-1892
Country	:	US
Telephone Number	:	561-452-5236
Fax Number	:

Provider Business Practice Location Address
First Line	:	5734 PAPAYA RD APT S
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33413-1892
Country	:	US
Telephone Number	:	561-452-5236
Fax Number	:

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

Provider Enumeration Date	:	08/22/2018
Last Update Date	:	01/02/2019

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