Carlos Rafael Dominguez

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

MH11165 Issued in FL

Practice address

12995 S Cleveland Ave
Fort Myers, FL 33907-3890

Phone

(305) 490-7178

NPI assigned

Jun 11, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Behavioral & Wellness Solution LLC

  • Behavior Analyst
  • Fort Myers, FL
  • NPI 1184394637
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567728000000",
    "number": "1689233751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12995 S CLEVELAND AVE STE 216",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339073807",
            "telephone_number": "305-490-7178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12995 S CLEVELAND AVE",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339073890",
            "telephone_number": "305-490-7178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINGUEZ",
        "first_name": "CARLOS",
        "middle_name": "RAFAEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-06-11",
        "last_updated": "2019-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": "FL",
            "license": "MH11165",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diana Emilies Dolz- Amiot, RBT
• Samantha Dombkowski, PHARMD
• Jorge Miguel Dominguez Gonzalbo
• Beatriz Dominguez Leon
• Amanda Dominguez
• Emely Dominguez
• Henry Dominguez
• Jasmin Dominguez
• Roberto Dominguez
• Tamara Dominick, ARNP

• Behavior Analyst in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Behavior Analyst in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.