MEDICARE: ROSA MARIA HERNANDEZ FERNANDEZ

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	20-129592	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013688779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSA MARIA HERNANDEZ FERNANDEZ

Provider Business Mailing Address
First Line	:	4251 NW 198TH TER
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-1843
Country	:	US
Telephone Number	:	786-587-6565
Fax Number	:

Provider Business Practice Location Address
First Line	:	4251 NW 198TH TER
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-1843
Country	:	US
Telephone Number	:	786-587-6565
Fax Number	:

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

Provider Enumeration Date	:	09/22/2021
Last Update Date	:	01/12/2022

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Directions to “ ROSA MARIA HERNANDEZ FERNANDEZ ” Practice Location

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