MEDICARE: YOSAN SANTIAGO 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	RBT25405797	FL

General Provider Information

NPI Number	:	1194539460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOSAN SANTIAGO FERNANDEZ

Provider Business Mailing Address
First Line	:	5605 LARIMER DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-4128
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5605 LARIMER DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-4128
Country	:	US
Telephone Number	:	813-570-4427
Fax Number	:

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

Provider Enumeration Date	:	02/05/2025
Last Update Date	:	02/05/2025

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Directions to “ YOSAN SANTIAGO FERNANDEZ ” Practice Location

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