MEDICARE: JAVIER HERNANDEZ RBT

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	106E00000X	Assistant Behavior Analyst	BACB1335742	FL
2	106S00000X	Behavior Technician	RBT25448030	FL

General Provider Information

NPI Number	:	1447148788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAVIER HERNANDEZ RBT

Provider Business Mailing Address
First Line	:	1500 NE 24TH AVE
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-1717
Country	:	US
Telephone Number	:	239-314-8044
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 NE 24TH AVE
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-1717
Country	:	US
Telephone Number	:	239-314-8044
Fax Number	:	239-314-8044

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

Provider Enumeration Date	:	06/25/2025
Last Update Date	:	06/26/2025

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