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General NPI Number Information
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NPI Number | 1730640582
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Entity Type | Individual
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Provider Name | JULIANNE ISABELLA FERNANDEZ
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Gender | Female
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Dates
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Enumeration Date | 03/26/2019
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Last Update Date | 07/26/2023
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Provider Practice Location Address
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Address Line | 1912 DAIRY RD
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City | WEST MELBOURNE
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State | FL
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Zip | 32904-4046
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Country | US
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Telephone | 321-413-3366
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Fax |
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Provider Business Mailing Address
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Address Line | 1275 POTENZA DR
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City | WEST MELBOURNE
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State | FL
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Zip | 32904-9220
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Country | US
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Telephone | 864-789-2557
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-21-54308
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License Number State | FL
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