Healthcare Provider Details

I. General information

NPI: 1013441799
Provider Name (Legal Business Name): YUDITH HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 NE 1ST PL
CAPE CORAL FL
33909-1952
US

IV. Provider business mailing address

613 NE 1ST PL
CAPE CORAL FL
33909-1952
US

V. Phone/Fax

Practice location:
  • Phone: 352-502-1722
  • Fax:
Mailing address:
  • Phone: 352-502-1722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-122350
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: