MEDICARE: ISYSMARY HERNANDEZ SERRAT

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-22-217203	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	:	1154060259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISYSMARY HERNANDEZ SERRAT

Provider Business Mailing Address
First Line	:	3739 MILANO LAKES CIR UNIT 401
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34114-2840
Country	:	US
Telephone Number	:	407-837-5525
Fax Number	:

Provider Business Practice Location Address
First Line	:	3739 MILANO LAKES CIR UNIT 401
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34114-2840
Country	:	US
Telephone Number	:	407-837-5525
Fax Number	:

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

Provider Enumeration Date	:	05/27/2022
Last Update Date	:	05/27/2022

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