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General NPI Number Information
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NPI Number | 1861044950
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Entity Type | Individual
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Provider Name | HEAVEN FERNANDEZ
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Gender | Female
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Dates
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Enumeration Date | 07/10/2019
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Last Update Date | 04/29/2026
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Provider Practice Location Address
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Address Line | 2391 NE LOOP 410 STE 304
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City | SAN ANTONIO
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State | TX
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Zip | 78217-5675
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Country | US
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Telephone | 505-489-3668
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Fax |
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Provider Business Mailing Address
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Address Line | 27777 INKSTER RD STE 100
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-5326
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Country | US
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Telephone | 248-436-4400
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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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Taxonomy #2
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | 10213
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 10213
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License Number State | TX
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