Provider Demographics
NPI:1679373039
Name:PEREZ DOMINGUEZ, BELLIS
Entity type:Individual
Prefix:
First Name:BELLIS
Middle Name:
Last Name:PEREZ DOMINGUEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6337 TREETOP CIR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-2715
Mailing Address - Country:US
Mailing Address - Phone:813-484-2314
Mailing Address - Fax:813-433-2430
Practice Address - Street 1:6337 TREETOP CIR
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-2715
Practice Address - Country:US
Practice Address - Phone:813-484-2314
Practice Address - Fax:813-433-2430
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-15
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist