Healthcare Provider Details

I. General information

NPI: 1669980454
Provider Name (Legal Business Name): ABA BLUE HOPE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10478 NW 132ND ST
HIALEAH GARDENS FL
33018-1121
US

IV. Provider business mailing address

2638 W 69TH TER
HIALEAH FL
33016-5483
US

V. Phone/Fax

Practice location:
  • Phone: 305-263-0789
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: YANDIRA HERNANDEZ FERNANDEZ
Title or Position: CEO
Credential: BCBA
Phone: 305-263-0789