Healthcare Provider Details

I. General information

NPI: 1033056965
Provider Name (Legal Business Name): RODOLFO HERNANDEZ LEON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4608 CONNIE AVE S
LEHIGH ACRES FL
33976-4732
US

IV. Provider business mailing address

4608 CONNIE AVE S
LEHIGH ACRES FL
33976-4732
US

V. Phone/Fax

Practice location:
  • Phone: 239-451-8186
  • Fax:
Mailing address:
  • Phone: 239-451-8186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-532286
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: