Individual
JUAN ANTONIO DOMINGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CBHCM
Contact information
Practice address
1905 NW 82ND AVE, DORAL, FL 33126-1011
(786) 420-5924
(786) 542-5340
Mailing address
8601 SW 94TH ST APT 110W, MIAMI, FL 33156-7364
(786) 641-0039
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
05/25/2022
Last updated
05/25/2022
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