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General NPI Number Information
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NPI Number | 1861023533
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Entity Type | Individual
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Provider Name | ALBA R FERNANDEZ LEAL RBT
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Gender | Female
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Dates
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Enumeration Date | 01/30/2020
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Last Update Date | 03/16/2023
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Provider Practice Location Address
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Address Line | 18935 NW 62ND AVE APT 104
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City | HIALEAH
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State | FL
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Zip | 33015-5054
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Country | US
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Telephone | 786-702-9370
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Fax |
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Provider Business Mailing Address
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Address Line | 2091 BAHAMA DR
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City | MIRAMAR
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State | FL
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Zip | 33023-2640
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Country | US
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Telephone | 786-702-9370
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-23-261172
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License Number State | FL
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