Healthcare Provider Details

I. General information

NPI: 1285309328
Provider Name (Legal Business Name): VANESSA LLANES HERNANDEZ BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 01/24/2022
Certification Date: 09/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 NW 77TH WAY
PEMBROKE PINES FL
33024-5229
US

IV. Provider business mailing address

1140 NW 77TH WAY
PEMBROKE PINES FL
33024-5229
US

V. Phone/Fax

Practice location:
  • Phone: 786-553-6999
  • Fax:
Mailing address:
  • Phone: 786-553-6999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-49940
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: