Healthcare Provider Details

I. General information

NPI: 1972326155
Provider Name (Legal Business Name): CARLOS MARCEL HERNANDEZ CANCIO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5274 SW 145TH AVE
MIAMI FL
33175-5732
US

IV. Provider business mailing address

5274 SW 145TH AVE
MIAMI FL
33175-5732
US

V. Phone/Fax

Practice location:
  • Phone: 305-467-2772
  • Fax:
Mailing address:
  • Phone: 305-467-2772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT24-378521
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: