Healthcare Provider Details

I. General information

NPI: 1790659837
Provider Name (Legal Business Name): KARINA MARIA HERNANDEZ CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2025
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6145 LAKE WORTH RD FL 33463A
GREENACRES FL
33463-3001
US

IV. Provider business mailing address

6145 LAKE WORTH RD STE A
GREENACRES FL
33463-3001
US

V. Phone/Fax

Practice location:
  • Phone: 561-421-0047
  • Fax: 561-421-0048
Mailing address:
  • Phone: 561-421-0047
  • Fax: 561-421-0048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-472939
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: