MEDICARE: ROSALIA HERNANDEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-24-332771	FL

General Provider Information

NPI Number	:	1023860368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSALIA HERNANDEZ

Provider Business Mailing Address
First Line	:	4036 RIVER BANK WAY
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33980-6515
Country	:	US
Telephone Number	:	239-822-7460
Fax Number	:

Provider Business Practice Location Address
First Line	:	4036 RIVER BANK WAY
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33980-6515
Country	:	US
Telephone Number	:	239-822-7460
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2024
Last Update Date	:	03/09/2026

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Directions to “ ROSALIA HERNANDEZ ” Practice Location

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