Healthcare Provider Details

I. General information

NPI: 1902741531
Provider Name (Legal Business Name): JANICE MARIE GUADALUPE HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10483 STAR FLOWER LN
RIVERVIEW FL
33578-9463
US

IV. Provider business mailing address

10483 STAR FLOWER LN
RIVERVIEW FL
33578-9463
US

V. Phone/Fax

Practice location:
  • Phone: 786-202-7715
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-395089
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: