Individual
CARLOS RAFAEL DOMINGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12995 S CLEVELAND AVE, FORT MYERS, FL 33907-3890
(305) 490-7178
Mailing address
12995 S CLEVELAND AVE STE 216, FORT MYERS, FL 33907-3807
(305) 490-7178
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
MH11165
FL
Other
Enumeration date
06/11/2019
Last updated
09/06/2019
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