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General NPI Number Information
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NPI Number | 1245989128
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Entity Type | Individual
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Provider Name | MRS. ROSE M HERNANDEZ
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Gender | Female
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Dates
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Enumeration Date | 03/19/2022
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Last Update Date | 03/19/2022
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Provider Practice Location Address
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Address Line | 6405 NW 36TH ST
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City | VIRGINIA GARDENS
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State | FL
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Zip | 33166-6974
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Country | US
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Telephone | 954-907-2233
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Fax |
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Provider Business Mailing Address
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Address Line | 817 CRYSTAL LAKE DR
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City | DEERFIELD BEACH
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State | FL
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Zip | 33064-1964
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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