MEDICARE: HERNANDEZ GLOVES CORP

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

General Provider Information

NPI Number	:	1124799127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERNANDEZ GLOVES CORP

Provider Business Mailing Address
First Line	:	6484 INDIAN CREEK DR APT 220
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-5813
Country	:	US
Telephone Number	:	954-598-1235
Fax Number	:

Provider Business Practice Location Address
First Line	:	6484 INDIAN CREEK DR APT 220
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-5813
Country	:	US
Telephone Number	:	954-598-1235
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GLEIDYS HERNANDEZ RODRIGUEZ
Credential	:
Telephone Number	:	954-598-1235

Provider Enumeration Date	:	09/21/2021
Last Update Date	:	09/21/2021

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