MEDICARE: ELIZABETH HERNANDEZ

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	H243-939-75-600-0	FL

General Provider Information

NPI Number	:	1154291193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH HERNANDEZ

Provider Business Mailing Address
First Line	:	12702 SW 228TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33170-2753
Country	:	US
Telephone Number	:	786-382-4862
Fax Number	:

Provider Business Practice Location Address
First Line	:	12702 SW 228TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33170-2753
Country	:	US
Telephone Number	:	786-382-4862
Fax Number	:

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

Provider Enumeration Date	:	11/06/2025
Last Update Date	:	11/06/2025

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Directions to “ ELIZABETH HERNANDEZ ” Practice Location

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