MEDICARE: JEANNETTE MARIE 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	106S00000X	Behavior Technician	BACB688958	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BACB688958	OTHER	PR	BACB

General Provider Information

NPI Number	:	1649939034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNETTE MARIE HERNANDEZ RBT

Provider Business Mailing Address
First Line	:	565 CALLE ABOLICION
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00918-4335
Country	:	US
Telephone Number	:	787-690-3231
Fax Number	:

Provider Business Practice Location Address
First Line	:	565 CALLE ABOLICION
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00918-4335
Country	:	US
Telephone Number	:	787-690-3231
Fax Number	:

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

Provider Enumeration Date	:	12/13/2021
Last Update Date	:	12/13/2021

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