MEDICARE: IRIS DE HOYOS

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

General Provider Information

NPI Number	:	1104323088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRIS DE HOYOS

Provider Business Mailing Address
First Line	:	1159 NW 4TH PL
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33993-1050
Country	:	US
Telephone Number	:	239-989-7423
Fax Number	:

Provider Business Practice Location Address
First Line	:	10491 BEN C PRATT/6 MILE CYPRESS PKWY STE 251
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-6514
Country	:	US
Telephone Number	:	239-691-6482
Fax Number	:

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

Provider Enumeration Date	:	04/09/2018
Last Update Date	:	04/09/2018

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Directions to “ IRIS DE HOYOS ” Practice Location

Language	Start Address	Practice Location

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