MEDICARE: LISMERY FERNANDEZ PEREZ

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	RBT-22-250122	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RBT-22-250122	OTHER		BACB BOARD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083327050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISMERY FERNANDEZ PEREZ

Provider Business Mailing Address
First Line	:	8411 N SUWANEE AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-3068
Country	:	US
Telephone Number	:	813-834-2899
Fax Number	:

Provider Business Practice Location Address
First Line	:	8411 N SUWANEE AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-3068
Country	:	US
Telephone Number	:	813-834-2899
Fax Number	:

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

Provider Enumeration Date	:	01/04/2023
Last Update Date	:	01/04/2023

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Directions to “ LISMERY FERNANDEZ PEREZ ” Practice Location

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