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General NPI Number Information
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NPI Number | 1679238406
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Entity Type | Individual
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Provider Name | ERNESTO FERNANDEZ MOREJON REGISTERED BEHAVIOR
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Gender | Male
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Dates
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Enumeration Date | 11/06/2021
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Last Update Date | 11/06/2021
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Provider Practice Location Address
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Address Line | 1600 SW SYLVESTER LN
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City | PORT ST. LUCIE
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State | FL
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Zip | 34984
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Country | US
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Telephone | 772-333-4411
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Fax | 771-353-5951
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Provider Business Mailing Address
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Address Line | 1549 SW FLAGAMI RD
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City | PORT ST. LUCIE
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State | FL
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Zip | 34953
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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 | RBT-21-173791
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License Number State | FL
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