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General NPI Number Information
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NPI Number | 1649077330
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Entity Type | Individual
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Provider Name | FERNANDO JORGE ENRIQUEZ
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Gender | Male
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Dates
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Enumeration Date | 02/28/2025
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 2812 YELLOW CREEK LOOP UNIT 211
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City | CAPE CORAL
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State | FL
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Zip | 33909-6543
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Country | US
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Telephone | 786-835-8521
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Fax |
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Provider Business Mailing Address
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Address Line | 777 NW 72ND AVE STE 1083
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City | MIAMI
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State | FL
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Zip | 33126-3176
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Country | US
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Telephone | 786-490-6307
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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 | RBT-25-413567
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License Number State | FL
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