Healthcare Provider Details

I. General information

NPI: 1174154470
Provider Name (Legal Business Name): HERIBERTO HERNANDEZ RUIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 09/29/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18082 SW 147TH CT
MIAMI FL
33187-1846
US

IV. Provider business mailing address

18082 SW 147TH CT
MIAMI FL
33187-1846
US

V. Phone/Fax

Practice location:
  • Phone: 305-924-8331
  • Fax:
Mailing address:
  • Phone: 305-924-8331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-20-11567
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT1998460
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: