MEDICARE: STEPHANIE HERNANDEZ-MIGUEL

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	:	1235724741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE HERNANDEZ-MIGUEL

Provider Business Mailing Address
First Line	:	2831 BUSINESS PARK CT STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-9010
Country	:	US
Telephone Number	:	725-600-3597
Fax Number	:	725-223-4688

Provider Business Practice Location Address
First Line	:	2831 BUSINESS PARK CT STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-9010
Country	:	US
Telephone Number	:	725-600-3597
Fax Number	:	725-223-4688

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

Provider Enumeration Date	:	03/05/2021
Last Update Date	:	03/05/2021

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Directions to “ STEPHANIE HERNANDEZ-MIGUEL ” Practice Location

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