Provider Demographics
NPI:1396633889
Name:RODRIGUEZ DOMINGUEZ, RAISEL
Entity type:Individual
Prefix:
First Name:RAISEL
Middle Name:
Last Name:RODRIGUEZ DOMINGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 NW 7TH ST APT 305
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-3165
Mailing Address - Country:US
Mailing Address - Phone:786-825-3301
Mailing Address - Fax:
Practice Address - Street 1:1501 NW 29TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-6623
Practice Address - Country:US
Practice Address - Phone:786-825-3301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI80742355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant