Healthcare Provider Details

I. General information

NPI: 1306697933
Provider Name (Legal Business Name): DIALENIS SANTANA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 SE 17TH AVE STE E
CAPE CORAL FL
33990-3801
US

IV. Provider business mailing address

511 PARKER AVE S
LEHIGH ACRES FL
33974-3609
US

V. Phone/Fax

Practice location:
  • Phone: 239-722-9608
  • Fax:
Mailing address:
  • Phone: 239-722-9608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: