Healthcare Provider Details

I. General information

NPI: 1700431970
Provider Name (Legal Business Name): JOEL HERNANDEZ JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 01/02/2023
Certification Date: 01/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

467 ALADDIN RD
SPRING HILL FL
34609-6402
US

IV. Provider business mailing address

467 ALADDIN RD
SPRING HILL FL
34609-6402
US

V. Phone/Fax

Practice location:
  • Phone: 813-748-7571
  • Fax:
Mailing address:
  • Phone: 813-748-7571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: