MEDICARE: GRETER HERNANDEZ RODRIGUEZ DEL REY

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	:	1144082884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETER HERNANDEZ RODRIGUEZ DEL REY

Provider Business Mailing Address
First Line	:	3060 BLUE HERON DR APT H
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-5233
Country	:	US
Telephone Number	:	786-681-6127
Fax Number	:

Provider Business Practice Location Address
First Line	:	3060 BLUE HERON DR APT H
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-5233
Country	:	US
Telephone Number	:	786-681-6127
Fax Number	:

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

Provider Enumeration Date	:	01/29/2024
Last Update Date	:	01/29/2024

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Directions to “ GRETER HERNANDEZ RODRIGUEZ DEL REY ” Practice Location

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