Healthcare Provider Details

I. General information

NPI: 1891620696
Provider Name (Legal Business Name): LIS ADRIANA FERNANDEZ FALCON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 FOXTAIL DR APT G1
GREENACRES FL
33415-6014
US

IV. Provider business mailing address

206 FOXTAIL DR APT G1
GREENACRES FL
33415-6014
US

V. Phone/Fax

Practice location:
  • Phone: 561-660-0281
  • Fax:
Mailing address:
  • Phone: 561-660-0281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-545631
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: