MEDICARE: JADENIS 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		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	:	1548882657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JADENIS HERNANDEZ

Provider Business Mailing Address
First Line	:	370 TAMIAMI CANAL RD
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-2545
Country	:	US
Telephone Number	:	786-838-8069
Fax Number	:

Provider Business Practice Location Address
First Line	:	370 TAMIAMI CANAL RD
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-2545
Country	:	US
Telephone Number	:	786-838-8069
Fax Number	:

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

Provider Enumeration Date	:	05/12/2020
Last Update Date	:	05/12/2020

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Directions to “ JADENIS HERNANDEZ ” Practice Location

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