MEDICARE: LOURDES 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-22-210509	FL

General Provider Information

NPI Number	:	1497489132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOURDES HERNANDEZ

Provider Business Mailing Address
First Line	:	1063 KOBUK ST
Second Line	:
City	:	HAINES CITY
State	:	FL
Zip	:	33844-8469
Country	:	US
Telephone Number	:	407-760-5320
Fax Number	:

Provider Business Practice Location Address
First Line	:	1063 KOBUK ST
Second Line	:
City	:	HAINES CITY
State	:	FL
Zip	:	33844-8469
Country	:	US
Telephone Number	:	407-760-5320
Fax Number	:

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

Provider Enumeration Date	:	07/09/2022
Last Update Date	:	07/09/2022

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Directions to “ LOURDES HERNANDEZ ” Practice Location

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