MEDICARE: ANA LIDIA HERNANDEZ MIRABAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	24-320710	FL

General Provider Information

NPI Number	:	1003672064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA LIDIA HERNANDEZ MIRABAL

Provider Business Mailing Address
First Line	:	8664 FORT SHEA AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-7494
Country	:	US
Telephone Number	:	732-619-8016
Fax Number	:

Provider Business Practice Location Address
First Line	:	3104 ORANOLE RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32810-2017
Country	:	US
Telephone Number	:	407-501-0494
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2024
Last Update Date	:	02/26/2024

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