=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205649001
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NELVA DEL CARMEN FERNANDEZ TORRES I
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2025
-----------------------------------------------------
Last Update Date | 01/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12964 MIZNER WAY
-----------------------------------------------------
City | WELLINGTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33414-8410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-888-2841
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12964 MIZNER WAY
-----------------------------------------------------
City | WELLINGTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33414-8410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-888-2841
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number | RBT-23-306622
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------