Active NPI
Laura Amelia Bazo Dominguez
- Behavior Technician
- Homestead, FL
National Provider Identifier
1699660431
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 25-436959
- Practice address
- 11323 SW 248TH Ter
Homestead, FL 33032-3442 - Phone
- (786) 367-4113
- NPI assigned
- Jun 11, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 25-436959 | FL | Primary |
Addresses
Primary practice location
11323 SW 248TH Ter
Homestead, FL 33032-3442
Mailing address
11323 SW 248TH Ter
Homestead, FL 33032-3442
Phone (786) 367-4113
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25-436959 | FL | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1749600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1749600000000",
"number": "1699660431",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11323 SW 248TH TER",
"city": "HOMESTEAD",
"state": "FL",
"postal_code": "330323442",
"telephone_number": "786-367-4113"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11323 SW 248TH TER",
"city": "HOMESTEAD",
"state": "FL",
"postal_code": "330323442",
"telephone_number": "786-367-4113"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAZO DOMINGUEZ",
"first_name": "LAURA",
"middle_name": "AMELIA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-06-11",
"last_updated": "2025-06-11",
"certification_date": "2025-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "FL",
"license": "25-436959",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Homestead, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.