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General NPI Number Information
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NPI Number | 1922874155
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Entity Type | Individual
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Provider Name | ERIKA L FERNANDEZ
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Gender | Female
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Dates
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Enumeration Date | 11/29/2023
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Last Update Date | 11/29/2023
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Provider Practice Location Address
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Address Line | 1533 SW DEL RIO BLVD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-1452
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Country | US
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Telephone | 973-207-9774
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Fax |
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Provider Business Mailing Address
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Address Line | 1533 SW DEL RIO BLVD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-1452
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Country | US
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Telephone | 973-207-9774
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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-23-309686
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License Number State | FL
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